Objective. To assess the cost implications of changing the ICU staffing model from a mandatory 24-hour in-house critical care specialist presence to a 16-hour coverage model with external supervision. Design. A pre–post comparison was undertaken among the prospectively assessed cohorts of patients admitted to our surgical ICU over a period of 3 years. Our data were stratified by case mixed index. Costs were modeled using a generalized linear model with log-link and gamma-distributed errors. Setting. Tertiary medical facility. Patients. All patients admitted to the adult surgical intensive care unit during the study period of June 2007 to April 2013. Intervention. Changing the ICU staffing model from a mandatory 24/7 in-house critical care specialist presence to a 16/7 model with robotic rounding in off hours. Results. A total cost model was calculated and evaluated. Total cost estimates of hospitalization were calculated for each patient. Length of stay and mortality were evaluated. Adjusted mean total cost estimates per case were 29% lower in the postimplementation period relative to the preimplementation period. Mean net revenue increased by 367% in the postimplementation period relative to the preimplementation period. Billing charges increased by more than 70% and billing collections increased by more than 40% with the new model. Length of stay was reduced by 33% with the 16-hour model versus the preimplementation time frame and maintained at the lower level during the measurement period. Mortality rate was 59% lower in the postperiod relative to the preperiod. Demand analysis for surgical ICU service, length of stay cost and capacity issues improved. Conclusions. We found that a 16-hour ICU that incorporates robotic rounding, without per diem intensivists, reduces length of stay, mortality, cost estimates, and actual costs. We have also shown an increase in mean net revenue and billing collections. The cost of introducing this staffing model has the potential to favorably impact overall costs. In this study, the 16-hour critical care service model performed favorably both in terms of quality and cost. Clinical implications. This model increases total savings generated for such patients in smaller ICUs, especially ones that predominantly care for lower acuity patients. Critical care interventions are expensive and have a narrow safety margin. It is essential to develop structured and validated approaches to study the delivery of this resource.

Michael H. Goldberg

Thomas Bily

Economic Benefit of a Novel Intensivist Coverage in a Surgical ICU

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