ICU patients and days of intensive care: A mathematical model optimizing the consequences of ICU unit function, intensive care and continual monitoring on incurred supplementary costs]

Introduction. - "Critical Care Units" are intended to admit patients with multiple organ failure. The severity of patients admitted is variable. The aim of the study was to estimate the number of days that an optimum care organization could release, and therefore the additional admissions that would have been allowed. Estimates of earnings related to the various supplements were carried out jointly. Methods. - Reporting days associated or not with a resuscitation care during the year 2011 in an ICU of a university hospital (16 beds), optimized patient flow simulation, and computation of medical act inducing financial supplements. Results. - Six hundred and fifty-seven patients (SAPS II from 0 to 110, 41% ventilated more than 48 hours, mortality = 26%) were admitted representing 5095 days (occupancy rate = 87%). Two hundred and twenty-two patients (34%) did not trigger supplement for resuscitation care for 415 days in the unit. Four hundred and thirty-five patients have triggered this supplement representing 4680 days, including 3035 days with resuscitation care and 1645 (35% of days valued resuscitation, 32% of total days) without any. The entire year 2011 has generated earnings of 3,980,192. Optimization of management would have allowed the admission of additional 235 to 295 patients and potential additional earnings from 524,735 to 1,063,804, depending on the occupancy rate chosen (80% or real 2011s) and the severity of discharged patients. Conclusion. - Optimization of the patients flow between "Critical Care", Intensive Care and Continuous Monitoring Units would increase the number of patients admitted in "Critical Care" Units without any financial loss related to supplements. (C) 2013 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.