Objective
This study documents the hospital costs of ICU patients diagnosed with early sepsis (first 24 hours of ICU admission) and compares their costs to those of other patients admitted to the ICU.
Data
Clinical and cost information on 1088 consecutive ICU admissions during 1999–2000 to the general medical/surgical ICU at Baystate Medical Center, the western campus of Tufts University School of Medicine, a community teaching hospital in Springfield, MA. Data collected in the ICU for the Project IMPACT database was merged with cost data from the hospital's cost accounting system to obtain costs based on actual use, not cost/charge ratios.
Methods
Patients were identified as early sepsis based on one of the following criteria; 1) primary acute ICU admission diagnosis of SIRS, septic shock, or Multi Organ Dysfunction Syndrome (MODS); 2) notation in the ICU log book of sepsis on admission; 3) infection at 24 hours plus evidence of hypotension, hypoperfusion or multiple organ dysfunction. Resource use measures computed for each patient included: a) total hospital costs incurred during the ICU stay, b) mean costs per ICU day, c) total costs incurred from ICU admission to hospital discharge, d) costs per day during ICU stay for specific cost categories (pharmacy, lab, imaging, respiratory therapy), e) ICU and total hospital (from ICU admission) length of stay (LOS).
Results
14.2% of patients admitted to ICU had early sepsis (n = 155). Comparison groups were respiratory diagnosis at ICU admission (n = 273, 25.1%) and all others (n = 660, 60.7%). Mean (± SD) cost of the ICU stay for early sepsis patients ($29,582 ± 39,399) was greater than for respiratory ($16,757 ± 15,439) and all other ($17,544 ± 23,712). Mean ICU LOS for early sepsis was 10.4 (± 12.6) days compared to 6.8 (± 6.1) days for respiratory and 5.8 (± 8.2) days for all other. Mean cost per ICU day for early sepsis was $2844 compared to $2464 for respiratory and $3025 for all other. Mean total costs and LOS (ICU admission to hospital discharge) for early sepsis patients ($39,949 ± 45,278), (19 ± 19.4 days) was greater than that for respiratory ($24,824 ± 21,347), (13.3 ± 11.7 days) and all others ($26,022 ± 29,870), (12.6± 12.7 days). Results for specific costs are as follows.
Conclusion
Compared to respiratory and other patients, mean total costs for patients admitted to ICU with early sepsis is 50% higher.
Table 1.
Mean cost for ICU stay
| Early | Respiratory | All other | |
|---|---|---|---|
| sepsis patients | patients | patients | |
| Pharmacy | 2625 ± 3555 | 1443 ± 1767 | 1436 ± 2495 |
| Lab | 2463 ± 3109 | 1127 ± 1220 | 1224 ± 2009 |
| Imaging | 1217 ± 1389 | 683 ± 653 | 784 ± 1100 |
| Respiratory | 2387 ± 3245 | 1791 ± 1809 | 1213 ± 2117 |
| therapy |