Use of severity stratified cost accounting and GI bleeding in a tertiary care ICU

INTRODUCTION: Acute GI Hemorrhage is a potentially life-threatening process considered to be a leading cause of ICU admission. Given the evolving trend to protocolize and limit ICU access for this diagnostic group, it is necessary to develop tools to ensure the preservation of medical outcomes and accurately characterize resource utilization/ costs to objectively assess the true effectiveness of changes in practice METHODS: During a 16-month period, 159 consecutive ICU GI bleed admissions were severity stratified and daily resource utilization/cost specific for ICU was determined via the hospital cost accounting system for nursing, respiratory therapy, radiology, pharmacy, and laboratory. Low risk was defined as 20% risk of death. RESULTS-SEE TABLE Resource utilization/cost primarily occurred in the ICU (58% total), was variable amongst GI diagnosis and was directly related to severity. For high and low risk UGI bleed, cost was highest on Day 1 and decayed daily for low risk, but was sustained for high risk patients. CONCLUSIONS: Objective severity stratified resource utilization that is temporarily characterized can be derived. This information can be applied to examine existent practice, define specific areas of improvement, and evaluate changes in practice. GI Bleed Costs (N = 159) UPPER (78) LOWER (33) VARICEAL (48) TOTAL (159) APACHE III 59 51 69 60 ICU LOS 3.58 4.70 5.73 4.46 ICU Cost $681,041.86 $436,611.76 $884,399.47 $2,002,053.09 ICU Cost/Day $2,438.91 $2,815.03 $3,215.53 $2,823.21 ICU Cost/Case $8,731.31 $13,230.66 $18,424.99 $12,591.53.