Research

Changes in hospital costs after introducing an intermediate care unit: a comparative observational study

Barbara CJ Solberg¹ , Carmen D Dirksen² , Fred HM Nieman² , Godefridus van Merode³ , Martijn Poeze⁴ and Graham Ramsay^4,5

¹Staff Department of Research, Care and Education, Maastricht University Hospital, P. Debyelaan 25 6229 HX Maastricht, The Netherlands

²Clinical Epidemiology and Medical Technology Assessment (KEMTA), P. Debyelaan 25 6229 HX Maastricht University Hospital, Maastricht, The Netherlands

³Department of Health Organisation, Policy and Economics (BEOZ), University of Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands

⁴Department of Surgery, P. Debyelaan 25 6229 HX Maastricht University Hospital, Maastricht, The Netherlands

⁵Current address: West Hertfordshire NHS Trust Hillfield Road, Hemel Hempstead, HP2 4AD, UK

author email corresponding author email

Critical Care 2008, 12:R68doi:10.1186/cc6903

Published:	15 May 2008

Abstract

Introduction

The high cost of critical care resources has resulted in strategies to reduce the costs of ruling out low-risk patients by developing intermediate care units (IMCs). The aim of this study was to compare changes in total hospital costs for intensive care patients before and after the introduction of an IMC at the University Hospital Maastricht.

Methods

The design was a comparative longitudinal study. The setting was a university hospital with a mixed intensive care unit (ICU), an IMC, and general wards. Changes in total hospital costs were measured for patients who were admitted to the ICU before and after the introduction of the IMC. The comparison of interest was the opening of a six-bed mixed IMC.

Results

The mean total hospital cost per patient increased significantly. Before the introduction of the IMC, the total hospital cost per patient was €12,961 (± €14,530) and afterwards it rose to €16,513 (± €17,718). Multiple regression analysis was used to determine to what extent patient characteristics explained these higher hospital costs using mortality, type of stay, diagnostic categories, length of ICU and ward stay, and the Therapeutic Intervention Scoring System (TISS) as predictors. More surgical patients, greater requirements of therapeutic interventions on the ICU admission day, and longer ICU stay in patients did explain the increase in hospital costs, rather than the introduction of the IMC.

Conclusion

After the introduction of the IMC, the higher mean total hospital costs for patients with a high TISS score and longer ICU stay explained the cost increase.