Explaining the amount of care needed by hospitalised surgical patients: a prospective time and motion study

BACKGROUND: Hospitals provide care for patients with a variety of diseases, co-morbidities and complications. The actual amount of care these patients need is unclear. Given the recent developments such as ageing, multi-morbidity and budgetary restraints, a practical explanatory model would avail healthcare professionals and managers in determining the demand and costs for clinical care. METHODS: Six surgical wards in a Dutch university hospital participated in this prospective time and motion study. Surgeons, nurses and paramedics recorded the time spent on patient care 24/7 by means of PDAs. The investigators extracted possible determining characteristics from a previous systematic review and expert focus group. Total amount of care needed by the patients was expressed as costs involved in medical and nursing time, surgical interventions and diagnostics. Afterwards the investigators applied linear regression analysis to detect significant independent characteristics. RESULTS: 174 Surgical patients were monitored during their hospital stay. Characteristics significantly influencing the consumed amount of care were: medication during hospitalisation, complications, co-morbidity, medical specialty, age, as well as undergoing surgery and length of stay. Median costs for care were €8.446 per patient admission. CONCLUSIONS: The investigators developed a model that explains the total demand and costs of care needed for surgical patients in a university hospital. The input for this instrument can be derived from readily available data in hospital databases. This makes it a relatively easy instrument to help healthcare professionals and managers appreciate the amount of care needed on (surgical) wards and may be used to appreciate trends in time.