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Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach

BACKGROUND: The aim of this study was to describe the case load, safety, and cost savings of critical care of the trauma patient provided at the surgical intermediate care unit (IMCU). METHODS: This cohort study included all trauma admissions between January 1, 2011 and January 7, 2015 at the gener...

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Autores principales: Plate, Joost D J, Peelen, Linda M, Leenen, Luke P H, Hietbrink, Falco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203138/
https://www.ncbi.nlm.nih.gov/pubmed/30402563
http://dx.doi.org/10.1136/tsaco-2018-000228
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author Plate, Joost D J
Peelen, Linda M
Leenen, Luke P H
Hietbrink, Falco
author_facet Plate, Joost D J
Peelen, Linda M
Leenen, Luke P H
Hietbrink, Falco
author_sort Plate, Joost D J
collection PubMed
description BACKGROUND: The aim of this study was to describe the case load, safety, and cost savings of critical care of the trauma patient provided at the surgical intermediate care unit (IMCU). METHODS: This cohort study included all trauma admissions between January 1, 2011 and January 7, 2015 at the general intensive care unit (ICU), stand-alone neuro(surgical) IMCU, and stand-alone (trauma) surgical IMCU. Trauma mechanism, Abbreviated Injury Scale score and Injury Severity Score (ISS), vital signs, laboratory parameters, admission duration, intubation duration, ICU transfer, and in-hospital mortality were prospectively collected. Hypothetical cost savings were calculated using the fixed cost price per IMCU (US$1500) and ICU (US$2500) admission day. RESULTS: A total of 1320 admissions were included, 675 (51.1%) at the IMCU and 645 (48.9%) at the ICU. Patients admitted at the IMCU had a median ISS of 17 (11, 22). Their median duration of admission was 32.8 hours (18.8, 62.5). At the IMCU, one patient died due to aneurogenic shock. A subsequent ICU transfer was required in 38 (5.6%) IMCU admissions. Of these transfers, four patients died due to neurological deterioration. At the ICU, the median ISS was 22 (14, 30). Nearly all (n=620, 96.3%) ICU trauma patients required mechanical ventilation. Expected total cost savings due to the presence of the IMCU were US$1 772 785. DISCUSSION: A substantial amount of trauma patients in need of critical care can safely be admitted at the IMCU, without the need for further mechanical ventilation. Thereby, the IMCU could fulfill an essential cost-saving role in the management of severely injured trauma patients. LEVEL OF EVIDENCE: Level IV.
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spelling pubmed-62031382018-11-06 Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach Plate, Joost D J Peelen, Linda M Leenen, Luke P H Hietbrink, Falco Trauma Surg Acute Care Open Original Article BACKGROUND: The aim of this study was to describe the case load, safety, and cost savings of critical care of the trauma patient provided at the surgical intermediate care unit (IMCU). METHODS: This cohort study included all trauma admissions between January 1, 2011 and January 7, 2015 at the general intensive care unit (ICU), stand-alone neuro(surgical) IMCU, and stand-alone (trauma) surgical IMCU. Trauma mechanism, Abbreviated Injury Scale score and Injury Severity Score (ISS), vital signs, laboratory parameters, admission duration, intubation duration, ICU transfer, and in-hospital mortality were prospectively collected. Hypothetical cost savings were calculated using the fixed cost price per IMCU (US$1500) and ICU (US$2500) admission day. RESULTS: A total of 1320 admissions were included, 675 (51.1%) at the IMCU and 645 (48.9%) at the ICU. Patients admitted at the IMCU had a median ISS of 17 (11, 22). Their median duration of admission was 32.8 hours (18.8, 62.5). At the IMCU, one patient died due to aneurogenic shock. A subsequent ICU transfer was required in 38 (5.6%) IMCU admissions. Of these transfers, four patients died due to neurological deterioration. At the ICU, the median ISS was 22 (14, 30). Nearly all (n=620, 96.3%) ICU trauma patients required mechanical ventilation. Expected total cost savings due to the presence of the IMCU were US$1 772 785. DISCUSSION: A substantial amount of trauma patients in need of critical care can safely be admitted at the IMCU, without the need for further mechanical ventilation. Thereby, the IMCU could fulfill an essential cost-saving role in the management of severely injured trauma patients. LEVEL OF EVIDENCE: Level IV. BMJ Publishing Group 2018-10-24 /pmc/articles/PMC6203138/ /pubmed/30402563 http://dx.doi.org/10.1136/tsaco-2018-000228 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Original Article
Plate, Joost D J
Peelen, Linda M
Leenen, Luke P H
Hietbrink, Falco
Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
title Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
title_full Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
title_fullStr Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
title_full_unstemmed Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
title_short Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
title_sort optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203138/
https://www.ncbi.nlm.nih.gov/pubmed/30402563
http://dx.doi.org/10.1136/tsaco-2018-000228
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