| OBJECTIVE:Recent years with the development of the medical system reform and theincreasing severity of the medical market competition, the "higher production withlower consumption" has been necessary for every hospital in the market economy.Performing cost accounting is to renew the opinion of hospital economicalmanagement, to raise the cost awareness of the hospital staff, to reduce wasting and toelevate social effects and economic returns of hospital, and to strengthen thecompetition ability in the market economy by auditing and managing the medicalservice cost. The cost calculation reflects the actual used-up resources. It is not tosave money, but to optimize resource allocation and utilization. Reasonable cost hasgradually become one of essences to judge hospital quality.CCU (coronary care unit) is a special ward for seriously injured sickness patientsto carry out cure and recover. Its cost is far higher than that of the usual patients. Inthe condition of the insufficient fund, the high cost of guardianship medical servicehas been the main problem for the department of health and society. The resources ofguardianship medical service are scanty but in fact are needed a large number. Tobalance the both we must make full use of the limited resources. In America guardianship cost every year is about 100 billion, which is up to 20％of the hospitalcost though the number of beds in guardianship room are less than 10％of the total.In England the expense in guardianship room every day is as 2—5 times as that in thegeneral ward. In budget and other restraint scope the manager of the guardianshiproom thinks about not only the cost but also the effect for more works. The costresearch of guardianship room can provide the information caused by cost and howthe cost is related to treatment activities, the character of the patients and theguardianship activity effect. Once the guardianship cost of the patients is calculated,we can analyze the reason of the cost and can make good use of the resources of theguardianship room. The cost accounting of CCU guardianship projects is a basewhich can make reasonable nursing price and judge the nursing serves beneficialresult and deploy the human resources rationally, and also the premise of reducingmedical cost. Only by cost accounting we can clearly understand the actualconsumption manpower, physical resource and financial resource that we provide topatients in medical service, and we can come up with the most effective andeconomical treatment and nursing plan, thus we can achieve a goal to cut down themedical cost and relieve the economical burden of patients.SUBJECTS and METHODS:The first part is to adopt convenience sampling. Choose two hospitals withthree levels of first-class, that is A hospital and the second hospital, and investigateCCU status quo and nursing workload. Questionaire is independently designed byreferring a large quantity of literature and listen to some related specialists'suggestion and pre-investigation. We should investigate nursing workload of CCUfrom two aspects. The first part is to determine the working hours of 84 patientshospitalized in A hospital CCU from February 2006 to June and analyze the working hours of each class and each nursing program respectively and their difference. Thesame to 40 patients hospitalized in the second hospital from 12-25, June, 2006. Wecan also analyze the relationship between nursing service and workload by this. Thesecond part is to collect the relevant information including the property report form,medical statistics report form, storehouse items of an account, payroll of nursing staffand the materials and labor service consumed in medical service of CCU in everyhospital. First we can ascertain all the guardianship cost and analyze the actual cost ofevery bed every day. By this we can discuss the standard cost accounting method ofCCU in every hospital. Statistical methods mainly include descriptive statistics,analysis of variance, t-test, correlation analysis and so on.RESULTS:1,analysis of nursing staff workload in CCUThe 84 patients in A hospital stayed in CCU from 1 to 6 days, the average nursingwork hour of every patient every day is 292.37±71.13min; the average nursing workhour of every patient every hour is 12.18±2.96 min; the 40 patients in second hospitalstayed in CCU from 1 to 6 days, the average nursing work hour of every patient everyday is 521.5±22.71min; the average nursing work hour of every patient every hour is21.73±0.95min.Both the A hospital and the second hospital mainly include clinical treatment andindirect nursing. In the A hospital working hours of clinical treatment and nursing arethe most and basically identical, next is life nursing. These nursing programs accountmore than 20% of all, working hours of respiratory passage management and mentalnursing account less than 10%. Whereas the working hours of indirect nursing in thesecond hospital are the most, basically accounting one third, working hours of clinical treatment, life nursing, observation and mental nursing accounting more than 10%respectively, and working hours of respiratory passage management are the least.By direct investigation to nursing working hours in the second hospital CCU, wefind that the everyday workload is different with different working lifetime of nursingstaff. The workload of nurses who work 5-10 years and 3-5 years is the largest andtheir average working hours are more than 8 hours regulated by our country. Theworkload of nurses who work 1-3 years is the least. Nurse's population and theworkload have the direct radio. The nurses who work 5-10 years are all mature invarious aspects and their technique is exquisite. They are the main power in CCU, atthe same time they accomplish more than a half of clinical works with the nurses whowork 3-5 years.The number of contract system nurse and registered nurse in the second hospitalCCU (including the nurse manager in CCU, they are all registered nurse) is the same,but contract system nurse has more workload than registered nurse and their workloadaccounts 60% of clinical workload, so they are the main power engaged in CCU.Nurse is the important resource of nursing service, thus reasonably disposing andeffectively utilizing the CCU nursing human resources are critical to assure the safetyof seriously injured sickness patients, cost reduction, quality and efficiency of nursingservice.2,Analysis on practical cost and standard cost for CCU guardianship program.By analysis of variance the days comparison for various patients in the A and thesecond and the third hospital CCU has statistical significance (p＜0.05). By correlationanalysis, cost and days for coronary person lived in CCU have the direct correlation,Pearson coefficient correlation r=0.863, p=0.000 (double); cost and the number ofcoronary person have the direct correlation, Pearson coefficient correlation r=0.774, p=0.003(double); cost and the number of hypertensive patients have the directcorrelation, Pearson coefficient correlation r=0.734, p=0.007 (double); cost and thenumber of other sickness plants have the direct correlation, Pearson coefficientcorrelation r=0.650, p=0.022 (double).By observation to bed usage of the three hospitals, we find that season, thesecurity sense the patients have to the hospital and the doctor's induction demandbehavior can affect bed usage. The high bed usage doesn't stand for the high income.By correlation analysis cost and bed usage have no correlation, Pearson coefficientcorrelation r=-0.204, p=0.525.Cost recovery rate and the number of accommodated patients have the inversecorrelation, Pearson coefficient correlation r=0.500, p=0.067 (double). Cost recoveryrate reflects charge level has covered the cost in the great degree. Cost recovery rateof CCU guardianship program is less than 100%a, that illustrates charge is lower thancost, the smaller the ratio, the less the cost usage; vice versa.Through the actual cost and the charge comparison, the A hospital actual costcompared to collects fees high 62%, the second hospital is high 94%, the thirdhospital is 23%. At the basis of actual cost, we approach the standard cost, standardcost one and two is higher than charge fees, the A hospital standard cost onecompared to collects fees high 50.4yuan, standard cost two compared to collects feeshigh 24.54yuan; the second hospital standard cost one compared to collects fees highl15.87yuan, standard cost two compared to collects fees high 120.94yuan; the thirdhospital standard cost one compared to collects fees high 0.27yuan.The more nursingtime thrown into and the more nurse population and the more for the patients, themore cost the division undertakes. Comparing the standard cost and the actual cost,we can know that increasing the number of patients accommodated and bedconversion rate can reduce human power cost and fixed cost, reduce the bed cost of every day of guardianship program, raise the CCU profit and become the norm forreference that clinical controls CCU cost.CONCLUSION:1,Treatment is the core of CCU nursing, next is life nursing, observation, mentalnursing, and respiratory tract nursing, indirect nursing in nursing service stillaccounts bigger portion.2,carry out nursing elasticity arranges in groups and perform all night shift andreduce the class changeable frequency according to patients population. Ensuringto monitor the seriously injured patients and nurse patients' body and mind isprofit to reduce the complication, precipitate recovery earlier, shorten the timestayed in hospital and reduce the patients' cost.3,Nurse is the important resource of nursing service, thus reasonably disposing andeffectively utilizing the CCU nursing human resources is critical to assure thesafety of seriously injured sickness patients, cost reduction, quality and efficiencyof nursing service.4,CCU guardianship program cost is related to the number of patients accommodatedand only shorten the days stayed in hospital and increase the patient population, wecan reduce the ratio of the fixed cost. This is the fundamental route to reduce thecost.
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