Cost Perceptions of Common Intensive Care Unit Interventions
CCCF ePoster library. Hendin A. Nov 8, 2018; 233375
Disclosure(s): This project was completed with assistance from a grant from The Ottawa Hospital Quality and Safety ICU Grants, 2017.
Dr. Ariel Hendin
Dr. Ariel Hendin
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Abstract
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Introduction: The cost of health care delivery continues to increase, and the care of critically ill patients in the Intensive Care Unit (ICU) comprises a large proportion of these costs – up to 20-30% of hospital budgets in North American studies1–3. Demand for ICU beds and occupancy rates continues to rise, and with ICU admissions increasing faster than overall hospital admissions, strategies to provide cost-effective, high quality ICU care are increasingly important2,4–8,9–12. In an effort to achieve cost-effective patient care, both Canadian and American Critical Care professional societies have developed Choosing Wisely guidelines that outline various measures to reduce unnecessary tests and treatments13–15.

Clinicians are generally unaware of the costs of interventions they order, which may exacerbate spending.16–20 There are few studies that assess the understanding ICU providers have of costs, and no Canadian studies of this issue16,17,21.

 

Objectives: Our study aimed to assess Canadian ICU health care providers’ understanding of the costs of interventions that, based on guidelines and literature, can likely be reduced while maintaining the quality of care. We wanted to assess the accuracy of multi-disciplinary team members at estimating the costs of these interventions, as the delivery of critical care is highly team-based.

 

Methods: This was a cross-sectional survey conducted in a large urban hospital comprised of two mixed medical/surgical ICUs. Eligible participants included all ICU physicians, fellows, registered nurses, pharmacists, and ICU administrators. A written questionnaire was created and piloted among a small group of ICU staff. Once edited, a survey consent and link to an electronic survey were distributed via an online platform to all ICU staff. Staff were asked to provide demographic data and specific estimates in Canadian dollars (CAD) of common interventions including lab testing, imaging tests, transfusions, and drug therapies. The primary study outcome was the accuracy of participants’ cost estimates as a percentage of actual direct costs. Correct estimates were defined as estimates within 25% above or below the actual costs. Data were analyzed with descriptive analyses utilizing Microsoft Excel.

 

Results: A total of 354 participants received the survey, of which 189 responded for a 53% response rate. Participants were 75.6% female and the majority (82.5%) were nurses or ICU physicians. Cost estimates including actual costs for comparison are found in Figure 1. As demonstrated in Figures 1 and 2, Participants grossly overestimated the cost of standard blood work and imaging tests. However, they significantly underestimated costs of transfusion therapies including red blood cells, albumin, and prothrombin complex concentrate. Participants also overestimated the cost of most drug therapies. Fewer than one-third of providers were accurate within 25% of the actual cost of any item.

 

Conclusions: This is the first Canadian study assessing the accuracy of health care providers’ estimates of the costs of tests and treatments in the ICU. Overall, very few providers could accurately estimate costs of standard ICU interventions. Participants significantly underestimated the cost of transfusions and related therapies, while they overestimated the cost of standard lab tests and imaging. Future studies should assess whether educational interventions around cost can improve ordering practices while maintaining quality of care.


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