Abstract
Critical care units are under increasing pressure to account for the large cost of managing complex patients. Ideally, cost-utilisation analysis (€/QALY) [1] should be used to assess treatment; however, this is very difficult in the uncontrolled environment of a working critical care unit with a heterogeneous patient population. Cost/ survivor is often used as a cost measure that considers outcome and is easier to measure; however, this is case-mix dependent so comparisons between units are flawed. We aimed to develop a measure of cost efficiency and quality that was independent of factors outside the control of each unit. We postulated that this could be achieved using a cost factor based on patient days weighted for average risk of death (RoD) and annual admission number [2], which along with the SMR would allow construction of a matrix that could assess both cost efficiency and outcome quality (the QES). Forty-seven units from the UK National Cost Block Programme (2003–2004) were included. Regression analysis was used to create a formula for cost/patient-day based on the admission number and RoD. Residuals representing the deviation from the predicted cost were plotted against the SMR. Units that had both low SMR and low cost (<95% CI) were considered to have high quality and high economy or high quality–efficiency (QE). Those with high SMR and high cost were considered to have low QE. We identified seven units that had high QE and six units that had low QE. We categorised units by cost/survivor and then assessed the QE categories in these terms. There was only limited correlation between the two methods. We believe that the QES is a relatively easy measure of both economic efficiency and quality, and may be a useful, powerful and convenient tool to assess critical care units. Figure 1
Highlights
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics
1Royal Brompton Hospital, London, UK; 2Medical University Graz, observation from mechanical deformation due to the tip of the Austria; 3Charles University Hospital, Prague, Czech Republic; endoscope we developed a flushing catheter that continuously
Taurocholic acid into the pancreatic duct. This allowed us to separate and to determine the specific role of pancreatic blood vs Introduction In the frame of protective lung ventilation, alveolar normal blood on the expression of injury evidenced during isolated biomechanics become more and more the focus of scientific lung reperfusion
Summary
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics. The thorax remains intact.decrease morbidity and mortality in critically ill patients [1] but is Results Figure 1 shows a tissue area after lavage of 0.8 mm difficult to achieve using standard insulin infusion protocols. Results Patient characteristics (mean ± SD): age 57.4 ± 15.4 years, 28 female, 52 male, APACHE II score 28.2 ± 6.6; number of organ failures 4.0 ± 1.12; preceding ICU period 8.5 ± 9.3 days; continuous sedation with midazolam 31.2 ± 34.2 mg/hour, fentanyl 0.12 ± 0.08 mg/hour, propofol 45.6 ± 105.2 mg/hour; sedation assessment according to RS 5.65 ± 0.63, CPS 5.15 ± 1.67, CKS 0.65 ± 0.69, CS 9.34 ± 2.13 und LSS 1.78 ± 1.69, RASS –4.50 ± 1.27, FiO2 0.52 ± 0.17, PEEP 8.2 ± 2.4 cmH2O, ventilatory frequency 20.5 ± 4.8/min, pressure control 16.8 ± 4.4 cmH2O, tidal volume 540 ± 115 ml, TVV 2525.6 ± 11,366 ml (minimum 1.52; maximum 91,586). We hypothesized that S100β levels correlate with this tumor’s preoperative characteristics and with perioperative neurological injury despite its supratentorial location and non-neural origin
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