Direct costs in the ICU

Based on the data collected during the EURICUS-I research, we propose a structure for calculating the direct cost of an ICU over a given period of time (e.g. 1 year)

(Table 1). With respect to resource management, the column headed 'units' is the most important. The values it contains must be compared with the output of the ICU

in order to assess its overall efficiency.

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Table 1 Structure for calculating the direct cost of an ICU

Comparison of resource use by ICUs should be made by comparing the physical input of resources. When comparing costs, care must be taken to standardize the 'prices' used to transform the number of resource units into cost.

This analysis can be refined by separating fixed costs from variable costs. As fixed costs are not influenced by the ICU's activity level, decision-making about the resources representing fixed costs should be of a different longer-term nature than decision making about variable resource input. Definition of activity level, which can be different for different kinds of resources representing variable costs, is a major problem. For example, TISS points provide a reasonable measure of nursing activity in the ICU, whereas the number of patients or patient-days is probably a better method of quantifying the use of pharmaceuticals.

When the data have been collected as described above, a cost structure for the ICU will emerge. It is also possible to define the cost structure per unit of output, such as patients, nursing-days, etc., or of groups of patients aggregated according to age, diagnosis, whether they are medical or surgical, outcome, etc. The cost of the various activities in the ICU (monitoring, mechanical ventilation, dialysis, etc.) can also be analyzed, so that the costs associated with the care requirements for any new patient or group of patients can readily be ascertained. It should be noted that the cost structure of the ICU should be re-evaluated periodically using a representative sample.

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