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- W2316578621 abstract "BACKGROUND: Intensive care staffing models vary amongst institutions. There is increasing evidence that in-house consultant care is beneficial in the intensive care unit (ICU). We have previously published beneficial results associated with 24hour/7-days a week in-house consultants working in a dedicated post-cardiac surgical unit. The cost-effectiveness of employing 24-hour/7-days a week in-house consultants (both in the postoperative cardiac surgery and the general systems ICU settings) remains largely unknown. The objective of this study was to analyze the cost implications of such a model. METHODS: Using prospectively collected information from the administrative and surgical databases, an observational beforeand-after cohort analysis of consecutive patients undergoing a cardiac surgical procedure at a single tertiary center was performed. The control cohort (n 1425) consisted of patients admitted to a traditional mixed surgical intensive care unit (SICU) from Jan.2005 Jan.2007. The intervention cohort (n 1824) consisted of patients admitted to a newly created cardiac surgery ICU (CICU) from Jan.2007 Sept.2008, which was staffed by 24/7 in-house consultants. Cost estimates were calculated for each patient from time of ICU admission to hospital discharge. Following propensity matching, categories including hospital bed, ICU physician salary, blood transfusion, laboratory, medication, and total hospital costs were compared between both models of ICU care. To allow for expensevariability, costs for each major category were varied based on a normal distribution with a standard deviation set at approximately 20% of the cost’s point estimate. After which 10,000 simulations were performed randomly choosing various cost points. RESULTS: 1,182 patients (83%) per cohort were matched. Preoperative demographics and surgical variables were similar between both cohorts. The CICU model of care had a significantly higher ICU physician salary cost. It was however associated with a significant reduction in hospital bed, laboratory, and blood transfusion costs. As a result, the total median cost was $7,145.09 [IQR $5,144 $12,123] for the SICU model versus $6,170.28 [IQR $4,694 $10,892] for the CICU model of care (p 0.001). The 10,000-simulation sensitivity analysis (Figure 1) demonstrated that despite varying the costs by / 20%, the majority of scenarios (85.4%, n 8,539) still favored the CICU model of care (median savings $980.81). CONCLUSIONS: We present a large before-after observational study examining the cost-effectiveness of 24/7 ICU consultant staffing. Our data suggests that the greater savings associated with improvement in post-operative care for patients following cardiac surgery offsets the salary costs associated with 24/7 inhouse consultants." @default.
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- W2316578621 date "2012-09-01" @default.
- W2316578621 modified "2023-09-23" @default.
- W2316578621 title "108 What is the Cost of Better Care For Patients Post-Cardiac Surgery? 24/7 In-House Consultant Staffing is a Cost-Effective Model" @default.
- W2316578621 doi "https://doi.org/10.1016/j.cjca.2012.07.117" @default.
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