The economic benefit of organizational restructuring of the cardiothoracic intensive care unit.
OBJECTIVE
Compare cost/benefits of organizational restructuring of the cardiac intensive care unit (CICU).


METHODS
Prospective, with a retrospective control period.


METHODS
Academic medical center.


METHODS
Sixty-six CICU patients (prospective) and 57 patients who received care before restructuring (retrospective) were compared. Entrance criteria were constant for both study periods.


METHODS
The CICU was restructured from a level III ICU to a level I ICU with the initiation of a consultant CICU service. The CICU service provided an attending physician dedicated to ICU care daily. All cardiac patients admitted into the CICU received consultation by the CICU service.


RESULTS
The average postoperative intubation time decreased during the intervention period (61% extubated within 6 hours v 12%, p = 0.004). Pharmacy, radiology, laboratory, and ICU costs decreased 279 US dollars (p = 0.004), 196 US dollars (p = 0.003), 190 US dollars (p = 0.15), and 470 US dollars (p = 0.12), respectively. The ICU length of stay (0.28 days shorter) as well as the overall postsurgery stay (0.54 days shorter) were reduced in the intervention period (p = 0.11 and 0.10, respectively).


CONCLUSIONS
The CICU service significantly reduced both total ICU-related costs ($1,173/patient) and overall costs (2,285 US dollars/patient) during the intervention period. Professional fees only reduced overall savings by 8%. These results indicate that organizational restructuring of the CICU to newer models can reduce costs associated with cardiac surgery.
Cannon
Mark A
MA
Department of Anesthesiology, Vanderbilt Medical Center, Nashville, TN, USA. marcann@wfubmc.edu
Beattie
Charles
C
Speroff
Ted
T
France
Daniel
D
Mistak
Bo
B
Drinkwater
Davis
D
D000368:Aged; D000776:Anesthesiology / Q000191:economics / Q000639:trends; D001803:Blood Transfusion / Q000191:economics / Q000639:trends; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000639:trends; D003362:Cost-Benefit Analysis / Q000191:economics / Q000639:trends; D005260:Female; D006754:Hospital Restructuring / Q000191:economics* / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000639:trends; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission / Q000191:economics / Q000639:trends; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000639:trends; D011446:Prospective Studies; D015642:Radiology, Interventional / Q000191:economics / Q000639:trends; D012138:Respiratory Therapy / Q000191:economics / Q000639:trends; D012189:Retrospective Studies; D013714:Tennessee; D019616:Thoracic Surgical Procedures / Q000191:economics* / Q000639:trends