Intensive care: cost and benefit

This study presents a review of 961 patients treated in the general intensive care unit (ICU) of Akershus Central Hospital (ACH) from 1978 to 1981, including also a follow-up study of the 419 patients treated in 1978 and 1979 who were observed for an average period of 20 months after admittance to the ICU. The ICU patients represented 1.7% of all the patients admitted to the referring departments. Approximately 2/3 (67.3%) of the patients were surgical patients, representing 2.9% of the patients treated in that department, 19.6% were medical patients, and 8.6% came from the department of pediatrics. Surgery was the main reason for ICU admittance in 48.1% of the patients; in 70% of these, surgery by itself made postoperative intensive care necessary. Acute or chronic cardiovascular or respiratory disorders caused or contributed to ICU admittance in 78% of the patients; disorders of the nervous system (29.0%), gastrointestinal system (25%), and severe infections (28%) came next. The average stay in the ICU was 6.2 days. The patient's need for observation, nursing and therapy was assessed daily according to a care grade scale from 1 to 5, with 5 as maximum effort. The average care grade during the stay, multiplied by the duration of stay in days, gave the care product, which was used as an expression of the patient's need for ICU resources. The sum of care products for all the patients through 1 year thus expressed the total work load on the ICU. The ICU budget for 1 year, divided by the total care product for the same year, and thereafter multiplied by the care product for single patients or patient groups, was used as the basis for calculation of ICU costs. Patients receiving mechanical ventilation required 95% of the total work load in the ICU, and 66.3% of these efforts were directly associated with the ventilator treatment period as judged by the care product. Complications to treatment were recorded in 7.3% of the patients, and four of these patients dies of such complications. Improvement by intensive care was achieved in 81.4% of the patients, 5.2% were unchanged, and 13.4% died while in the ICU. Mortality was 9.5% below and 19.3% above the age of 60 years. Of the 419 patients who were followed for an average period of 20 months after admittance to the ICU, 56 died in the ICU, 28 died later during the same stay in ACH, and another 47 died after discharge from ACH, whereas 288 (68.7%) were still alive.(ABSTRACT TRUNCATED AT 400 WORDS)