Comparative Assessment of Patient Care Expenses among Intensive Care Units of a Tertiary Care Teaching Hospital using Cost Block Method

Introduction:

Intensive care services of a hospital are found to consume major chunk of hospital resources as well draining the savings of patients. Implementing proper control measures facilitates effective functioning of critical care services.

Aim:

Identify various costs involved in operating Surgical Intensive Care Unit (SICU) and Respiratory Intensive Care Unit (RICU); also find out the running cost of the same.

Methodology:

Retrospective data was collected for 12 months period and prospectively through informal interactions with staff.

Results:

Construction and estate costs of the respective ICU's were found to be high, followed by laboratory charges. Running cost of RICU was found to be more than SICU.

Conclusion:

Costing of intensive care service is essential for controlled operations and to provide efficient patient care.

Stress levels of critical care doctors in India: A national survey

Background:

Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill.

Aim:

The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India.

Materials and Methods:

A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12). Completely filled 242 responses were utilized for comparative and correlation analysis.

Results:

Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU) followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%), anxiolytic or antidepressants (18%) and smoking (14%).

Conclusion:

Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour.

Critical care medicine in Nepal: where are we?

Although critical care medicine has been established as a separate specialty in the rest of the world it is still in its initial stages of development in Nepal and intensive care units (ICUs) here are still in primitive stages. This article describes the history, the types and current status of ICUs, the challenges, and academic training and certification in critical care medicine in Nepal, compared with existing ICUs in other parts of the world.

Reimbursement for critical care services in India

There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India.

Cost of intensive care in India

Critical care is often described as expensive care. However, standardized methodology that would enable determination and international comparisons of cost is currently lacking. This article attempts to review this important issue and develop a framework through which cost of critical care in India could be analyzed.