Cost accounting of adult intensive care: methods and human and capital inputs.
OBJECTIVE
To cost adult intensive care by determining inputs to production, resource consumption per patient, and total cost per intensive care unit (ICU) stay.


METHODS
Prospective cost-accounting analysis of each patient stay in the ICU, over a 1-yr period.


METHODS
An 11-bed, medical/surgical adult ICU, in a 932-bad urban teaching hospital.


METHODS
All patients' admissions to an adult ICU over a 1-yr period, excluding those patients admitted solely for repeat hemodialysis.


METHODS
None.


RESULTS
Demographic information was collected, including age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II score, primary reason for ICU admission, operative (elective and emergency) and nonoperative status, ICU length of stay, and ICU outcome. Direct patient care costs were accounted to individual patients whose care generated those costs, and indirect patient care costs were averaged over all patients in the ICU on a daily basis. Costs were collected for human (nursing, medical, professional, and support staff) and capital (laboratory, diagnostic imaging, supplies, drugs, and equipment) resources. Cost information was available on 690 patients (43% female, 57% male). Cost/day/patient was $1,508 +/- 475 (1992 Canadian dollars) and the average cost per ICU stay was $7,520 +/- 11,606. Median cost/stay for all patients was $2,600. Cost per ICU stay was < $5,000 in 68% of patients, with an ICU survival rate of 85%. High cost was not a marker for poor survival. There was no relationship between age and cost categories. Across most diagnoses, cost/ day/patient was remarkably constant, approximating $1,500/day/ patient at existing labor rates.


CONCLUSIONS
In order to develop strategies aimed at cost containment, it is first necessary to undertake a thorough examination of cost drivers. This detailed cost-accounting study determined inputs to production, resources consumed by individual patients, and costs incurred during ICU stay.
Noseworthy
T W
TW
Department of Adult intensive Care, Royal Alexandra Hospitals, University of Alberta, Edmonton, Canada.
Konopad
E
E
Shustack
A
A
Johnston
R
R
Grace
M
M
D018806:APACHE; D000328:Adult; D002170:Canada; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay; D008297:Male; D013514:Surgical Procedures, Operative; D000078329:Workforce