Study On Actual Cost And Standard Cost Of Critical Care In Cardiovascular Surgical ICU Of Three Grade Ⅲ-A General Hospital

Objective: The cost of ICU is very expensive, and the workload of nursing staff is very heavy. The present study is intended to analyze the actual cost and standard cost of critical care in the ICU of thoracic and cardiovascular surgery, to find if there is the difference between the cost of critical care nursing and the price of critical care service, and if the fee reflects the workload of nursing staff actually. These results would helpful to evaluate nursing productivity and allocate critical care nursing resource as well as identifying value of nursing practice in China.Measurements and results: By means of field investigation in thoracic and cardiovascular ICU of three hospitals, we got 86 items in critical care nursing. Through the 24-hour-investigation in different patient in two ICUs, the direct time and indirect time of nursing activities is recorded, and the time of every item was measured. Meanwhile we also measured the workload of patients who past different surgery in order to realize the specialties of nursing workload of different shift and of different diagnosis, to find out the issue in the utilization of nursing manpower, and these would be helpful to arrange the critical care nursing resource reasonably. According to the principle of cost accounting in hospital, we surveyed all of the cost composing about the critical care and calculated the actual cost of it. And these results would be helpful to evaluate the cost composing of the critical care and to find the difference between the fee and the cost, and the facts which would influence the cost. With two methods, the standard cost of critical care was accounted. Theseresults would help us understand the cost when the nursing staffs were allocated in standard or ICU beds were in use completely, and realize the relation between the standard cost, the actual cost and the charges. Therefore, it would helpful for policy-making agency to make correct price of critical care.Conclusion: The results showed that(l)There was a variance between service fee aLd cost. The actual cost of critical care nursing is higher than the standard price. The more severe the patient is, the higher the actual cost will be. The more use of high technique equipment, the less we would take back. (2)The workload of ICU of thoracic and cardiovascular surgery is related to diagnosis, post days and shift; The perfect of the work procedure with ways and the management system of ICU, is a key to eradicate every kind of loophole completely and guarantee the nursing quality. The difference of nursing manpower and nurse diathesis, the variance of the management principle, will all affect the nursing workload and the quality of the ICU, the shortage of nursing manpower will cause the phenomenon of the "more technique, less care". (3)If the nursing manpower were allocated according to the standard ratio (1:2), the item cost would not rise obviously, but sufficient manpower is quality guarantee. Therefore, governor must consider the cost and benefit of ICU in integration. The reduction of nurses persistently would cause the steep rise of nursing workload with the nursing quality falling down.