Skip to main content

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

Back to article

  1. Changes in hospital costs after introducing an intermediate care unit (IMC); wrong metrics will yield misleading results.

    Chiedozie Udeh, University of Iowa

    10 June 2008

    ICU costs are mostly fixed (nurses and ancillary staff, ventilators, monitors) with a smaller component of variable expenses on consumables. Shifting care to IMC may reduce costs for individual patients; overall hospital-wide savings requires reduced variable expenses in the short term and fixed expenses in the mid-to long term:

    • Labor costs should be less than if all higher level care occurs in ICUs (lower nurse-patient ratios).

    • ICU utilization should decrease

    • Redeployment of redundant nursing capacity or eventual elimination of the positions.

    Viewed thusly, Solberg et al merely demonstrated the cost impact of unmasking and filling a hitherto unmet need for extra surgical ICU capacity at their institution:1 Effectively 271 more patients (143 + (457 – 329) received higher level care with the additional ICU patients coincidentally having higher TISS scores and LOS. Not surprisingly, introducing the IMC did lead to increased total hospital costs but only insofar as it resulted in freed up ICU capacity. One wonders if the increase in ICU admissions resulted in decreased demand for recovery room overflow capacity, perhaps saving unplanned overtime costs

    A retrospective comparison of costs of care for IMC patients with a matched cohort from the pre-IMC period may have been a better approach. If the hypothesis were true, the IMC patients would have incurred lower costs. It is worth emphasizing that even without increased utilization of the freed ICU beds, only mild impact on costs would be expected unless the excess ICU nurse capacity could easily be re-deployed.

    References

    1. Solberg BC, Dirksen CD, Nieman FH, van Merode G, Poeze M, Ramsay G: Changes in hospital costs after introducing an intermediate care unit: a comparative observational study. Crit Care 2008; 12: R68

    Competing interests

    None declared

Advertisement