Pediatric critical care cost containment: combined actuarial and clinical program.
OBJECTIVE
To determine if providing patients' daily survival probabilities to physicians and nurses along with a short videotape on the measurement of survival probabilities and costs of pediatric intensive care would reduce resource use.


METHODS
Prospective, randomized, controlled trial.


METHODS
Pediatric ICU.


METHODS
Medical patients in a prospective control period (n = 113), an intervention period (n = 226), and a follow-up control period (n = 97).


METHODS
The survival probabilities of 50% of the patients in the intervention period were displayed at the bedside and the staff viewed a short videotape on the measurement of survival probabilities and costs of pediatric intensive care.


RESULTS
Daily survival probabilities and resource use were evaluated each day. Resource use, adjusted for severity of illness, was evaluated using analysis of covariance. Compared with the prospective control group, reductions in the daily use of blood gases (p less than .01), hematology tests (p less than .001), hourly vital signs (p less than .001), and hourly neurologic vital signs (p less than .001) resulting in a composite reduction in daily laboratory and imaging charges from $759 +/- $22 to $622 +/- $18 (p less than .01) were observed in the patient group receiving the survival probabilities and whose physicians also viewed the videotape. Equivalent reductions in resource use also occurred in a simultaneous control group (patients did not receive survival probabilities but healthcare workers did view the videotape) and in a follow-up control group.


CONCLUSIONS
Reduction in pediatric intensive care resource use can occur from the combined effects of actuarial and clinical interventions.
Pollack
M M
MM
Children's Hospital National Medical Center, Washington, DC 20010.
Getson
P R
PR
D000206:Actuarial Analysis; D002675:Child, Preschool; D003363:Cost Control; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004363:Drug Utilization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000191:economics*; D007755:Laboratories, Hospital / Q000706:statistics & numerical data; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D009026:Mortality; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index