The cost of intensive care medicine in Germany. Outcome of a benchmark survey of 110 anaesthesiological ICUs on the basis of the actual costs in 2009

Background: In 2003 the cost analysis of German intensive care units for the year 1999 was published by the working group "Anaesthesia and Economics" of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anaesthetists (BDA). One of the aims of the original study was, in view of the upcoming introduction of the DRG system, to analyse the cost data of German intensive care units headed by anaesthetists. The objective of the follow-up study presented here was to analyse the 2009 cost data of German intensive care units to obtain a current picture of the cost situation 10 years after the first study and 6 years after the introduction of the DRG-System. Methods: In June 2010 all members of the German Society of Anaesthesiology and Intensive Care Medicine recorded as "Head of Department" were invited to participate in a postal survey. The questionnaire was based in part on the original 1999 cost analysis by Prien et al. It comprised sections dealing with the hospital, its resources and departments, the intensive care unit with its personnel and equipment, and the cost data for the year 2009. For data analysis the ICUs were clustered according to hospital size (499 beds, university hospitals). Data were analysed using MS Excel 2003 and IBM SPSS Statistics 19. Results: 110 anaesthetist-headed ICUs participated in the study. The number of beds per ICU increased with increasing size of the hospital. The percentage of intensive care patients on ventilatory support varied between 20% (small hospitals) and 50% (university hospitals). The ratio of nursing and physician staff per bed was appreciably higher in university hospitals than in the other hospital types (nursing: 0.35 +/- 0.07 beds per nurse vs. 0.52 +/- 0.13; 0.53 +/- 0.14; 0.49 +/- 0.11; physician: 1.4 +/- 0.3 beds/physician vs. 1.9 +/- 0.6; 2.1 +/- 0.7; 2.2 +/- 0.7). The costs for drugs and materials were higher for university hospitals (drugs: 155 +/- 72 euros vs. 55 +/- 29; 73 +/- 30; 81 +/- 28 euros; materials: 129 +/- 85 euros vs. 64 +/- 45; 77 +/- 60; 86 +/- 45 euros). In comparison to the 1999 study the higher costs for physicians contrast with a stagnation of inflation-adjusted nursing costs; the costs of drugs in university hospitals and the material costs in all hospital groups have increased considerably. The accurate assignment of costs to intensive care units and to individual cases apparently continues to be a problem for the hospital administration, even 6 years on from the introduction of the DRG system. A case-severity adjustment of costs proved impossible, due to inadequate recording of case severity data. Conclusions: Intensive care cost transparency remains less than optimal, so that benchmarking would seem possible only on the basis of a staff count. Adjustment for case severity, however, continues to be indispensable

The Effect of Hospital Size and Surgical Service on Case Cancellation in Elective Surgery

BACKGROUND: Short-term case cancellation causes frustration for anesthesiologists, surgeons, and patients and leads to suboptimal use of operating room (OR) resources. In many facilities, > 10% of all cases are cancelled on the day of surgery, thereby causing major problems for OR management and anesthesia departments. The effect of hospital type and service type on case cancellation rate is unclear. METHODS: In 25 hospitals of different types (university hospitals, large community hospitals, and mid-to small-size community hospitals) we studied all elective surgical cases of the following subspecialties over a period of 2 weeks: general surgery, trauma/orthopedics, urology, and gynecology. Case cancellation was defined as any patient who had been scheduled to be operated on the next day, but cancelled after the finalization of the OR plan on the day before surgery. A list of possible cancellation reasons was provided for standardized documentation. RESULTS: A total of 6009 anesthesia cases of 82 different anesthesia services were recorded during the study period. Services in university hospitals had cancellation rates 2.23 (95% confidence interval [CI] = 1.49 to 3.34) times higher than mid-to small-size community hospitals 12.4% (95% CI = 11.0% to 13.8%) versus 5.0% (95% CI = 4.0% to 6.2%). Of the surgical services, general surgical services had a significantly (1.78, 95% CI = 1.25 to 2.53) higher cancellation rate than did gynecology services-11.0% (95% CI = 9.7% to 12.5%) versus 6.6% (95% CI = 5.1% to 8.4%). CONCLUSIONS: When benchmarking cancellation rates among hospitals, comparisons should control for academic institutions having higher incidences of case cancellation than nonacademic hospitals and general surgery services having higher incidences than other services. (Anesth Analg 2011; 113: 578-85