Volume 1 Supplement 1

17th International Symposium on Intensive Care and Emergency Medicine

Open Access

Cost-effectiveness of a paediatric retrieval service

  • IA Murdoch1,
  • T Sajjanhar1,
  • S Tibby1,
  • M Hatherill1 and
  • MJ Marsh1
Critical Care19971(Suppl 1):P126

https://doi.org/10.1186/cc97

Published: 1 March 1997

Introduction

Paediatric intensive care is expensive and accounts for a large share of inpatient expenditure. Recently, it has been claimed that not only is transfer of critically ill children best performed by specialist paediatric retrieval services (PRS) [1] but the use of such services should reduce the health care costs of these patients [2]. We report the effect a PRS has had on cost-effectiveness within the PICU, specifically: the median cost per survivor (CPS) and non-survivor (CPNS) and the effective cost per survivor (ECPS) within defined mortality risk intervals. Predicted mortality was calculated from the patients admission PRISM score, for both retrieved (R) and non-retrieved (NR) patients during the period 1 January 1994-31 December 1995. ECPS was determined by summing the total costs incurred within each mortality risk interval and dividing the sum by the total number of survivors.

Patients and methods

Guy's Hospital has a 120 bedded children's hospital, with 16 PICU beds. Each retrieval team incorporates two doctors, the lead clinician being either a Consultant or Fellow together with a resident, and one nurse. Since January 1995, the unit has had the ability to run two PRS simultaneously.

Results

The table shows the median costs incurred for CPS and CPNS. The ECPS is also given. All costs are in pounds Sterling (£). Costs were allocated from the use of patient TISS points. The value of a TISS point in 1994 and 1995 was £34.70 and £33.80 pounds, respectively. N0 records the number of patients within each mortality risk interval and (*) denotes deaths.

The mean predicted risk, the standardised mortality ratios (all less than 1) and the median length of PICU stay (days) for NR versus R patients were not significantly different within comparable mortality risk intervals (data not shown).

Conclusion

We can find no supportive evidence to show that surviving patients retrieved by specialist staff do indeed have reduced health care costs; to the contrary the trend is towards them being more costly.

Table

 

Non-retrievals (n = 88)

Retrievals (n = 255)

Mortality risk intervals

N0/(*)

CPS

CPNS

ECPS

N0/(*)

CPS

CPNS

ECPS

<1%

17/0

1526

N/A

2220

47/0

1757

N/A

3252

1-5%

40/1

2248

5577

3352

99/0

2433

N/A

4486

5-15%

12/0

2759

N/A

3130

62/6

3905

5015

5870

15-30%

6/1

4434

4930

7657

23/5

3019

3143

6180

>30%

13/6

3956

4390

8114

24/10

4293

3145

14,544

Authors’ Affiliations

(1)
Paediatric Intensive Care Guy's Hospital

References

  1. Edge WE, et al: Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med. 1994, 22: 1186-PubMedView ArticleGoogle Scholar
  2. MacNab AJ: Optimal escort for interhospital transport of Paediatric emergencies. J Trauma. 1991, 31: 205-PubMedView ArticleGoogle Scholar

Copyright

© Current Science Ltd 1997

Advertisement