Managing cost in ICU - a report of an experience

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Background

Costs have a huge impact in ICU bills and are the subject of many articles in the medical literature. To reduce costs without decreasing quality is a challenge.

Objectives

To demonstrate a cost management program in a 12-bed ICU of a general hospital with 72 beds. We've chosen three drugs of great impact in the bill and we've established a program that rationalized or replaced these drugs and a way to control if there was any negative impact on quality.

Methods

The period of the study was from January 1998 to July 1999. The three drugs chosen were human albumin, omeprazole and midazolan. To decide when and how to use albumin and omeprazole, we employed evidence-based medicine concepts; with midazolan, we changed to diazepam, in equivalent doses, and controlled the "ideal doses" by the Ramsay scale.

Results

We achieved a considerable reduction in global costs, specifically US$ 20 000 for albumin, US$ 3200 for omeprazole and US$ 2000 for midazolan, each month. The global economy was US$ 277 000 a year, without major mortality (compared to predicted by the APACHE II score), increased length of stay (LOS), discomfort or difficulties inside the medical group. The benefits are maintained until now (19 months later).

Conclusion

Control costs without loss of quality is a challenge and a duty. We proved that this is possible without any problem. It's necessary to have clear targets and scientific basis, as evidence-based medicine, in conducting the protocols. Other areas are being included in this approach in our group.