205 MONITORING PATIENTS IN A PICU: COST CONTAINMENT POTENTIAL

Abstract

ICU's are expensive and account for∼1% of the GNP. Many patients (pts) without life threatening dysfunction and not utilizing unique PICU therapies who receive only monitoring could be cared for in other hospital areas at a significant cost savings. Methods: All admissions to a 16 bed PICU for 13.5 months were evaluated. Daily assessemnts of types of care were accomplished with the Therapeutic Intervention Scoring System (TISS). Each of the TISS components were categorized as PICU therapies (e.g. mech ventilation), mentoring: personal intensive (e.g. hourly vital signs), monitoring: technology intensive (e.g. arterial catheter) and routine care. Daily assessments of severity of illness utilized the Physiologic Stability Index (PSI). Patients were divided into low (mortality risk

Results: 822 admissions utilizing 3969 days of care were evaluated. 226 pts (27.5%) utilizing 297 days of care (7.5%) did not receive unique PICU therapies (monitoring pts). 94.2% (213/266) were at low risk. A single diagnosis or clinical service did not predominate. Most care modalities used by the monitoring pts were personnel intensive (e.g. hourly VS − 82.7%, accurate I/O - 56.6%, mult stat studies - 45.1%). 93.8% of monitoring pts stayed ≤ 2 days.

Conclusions: 1) Significant numbers of PICU pts never recieve unique benefits from their PICU stay. 2) Most monitoring pts are at low risk. 3) Protocols for improving PICU efficiency should be directed at screening admissions rather than reducing stay and should concentrate on care needs, not diagnostic entities.

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