Costs of adverse events in intensive care units
Costs of adverse events in intensive care units
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DOI：
10.1097/01.ccm.0000284510.04248.66
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发表时间：
2007-11-01
影响因子：
8.8
通讯作者：
Rothschild, Jeffrey M.
中科院分区：
文献类型：
--
作者：
Kaushal, Rainu;Bates, David W.;Rothschild, Jeffrey M.
上下文。子宫源性损伤在危重成人中非常常见。然而，这些事件的财政影响尚未完全了解。目的：确定内科重症监护病房和心脏重症监护病房患者不良事件的成本。设计、环境和患者。我们对一家学术性三级城市医院内科重症监护病房和心脏重症监护病房患者进行了一项为期1年的前瞻性观察研究（2002年7月至2003年6月）收集的数据进行了匹配病例对照分析。本研究共匹配108例病例和375例对照。主要结果测量。护理费用和住院时间由医疗和心脏重症监护病房患者的医院账单系统确定。然后，我们确定了在重症监护病房中，与没有不良事件的患者相比，有不良事件的患者的增量成本和住院时间。对于在重症监护病房住院期间第二天发生第二次不良事件的患者，费用被截断。对于56名重症监护室患者，不良事件的成本为3,961美元（p = 0.010），住院时间增加了0.77天（p = 0.048）。由此推断，在医疗加护病房发生不良事件的年费用为85.3万美元。同样，对于52名心脏重症监护病房患者，不良事件的成本为3,857美元（p = 0.023），相当于每年63万美元的成本。平均而言，在心脏重症监护病房发生事件的患者住院时间增加了1.08天（p = 0.003）。结论：需要重症监护的患者尤其有不良事件的风险，这些事件的相关费用是可观的。不良事件的成本可能证明进一步投资于预防策略是合理的。
Context. latrogenic injuries are very common in critically ill adults. However, the financial implications of these events are incompletely understood.Objective: To determine the costs of adverse events in patients in the medical intensive care unit and in the cardiac intensive care unit.Design, Setting, and Patients. We performed a matched case-control analysis on data collected during a prospective 1-yr observation study (July 2002 to June 2003) of medical intensive care unit and cardiac intensive care unit patients at an academic, tertiary care urban hospital. A total of 108 cases were matched with 375 controls in our study.Main Outcome Measures. Costs of care and lengths of stay were determined from hospital billing systems for patients in the medical and cardiac intensive care units. We then determined the incremental costs and lengths of stay for patients with adverse events compared with patients without events while in the intensive care unit. Costs were truncated for patients with a second adverse event on a subsequent day during the intensive care unit stay.Results. For 56 medical intensive care unit patients, the cost of an adverse event was $3,961 (p =.010) and the increase in length of stay was 0.77 days (p =.048). This extrapolated to annual costs of $853,000 for adverse events in the medical intensive care unit. Similarly, for 52 cardiac intensive care unit patients, the cost of an adverse event was $3,857 (p =.023), corresponding to $630,000 in annual costs. On average, patients with events in the cardiac intensive care unit had an increase of 1.08 days in length of stay (p =.003).Conclusions: Patients who require intensive care are especially at risk for adverse events, and the associated costs with such events are substantial. The costs of adverse events may justify further investment in prevention strategies.