Treatments costs associated with inpatient clinical deterioration

Kate Curtis; Prabhu Sivabalan; David S Bedford; Julie Considine; Alfa D'Amato; Nada Shepherd; Tiana Elphick; Ramon Z Shaban; Margaret Fry

doi:10.1016/j.resuscitation.2021.07.022

Treatments costs associated with inpatient clinical deterioration

Resuscitation. 2021 Sep:166:49-54. doi: 10.1016/j.resuscitation.2021.07.022. Epub 2021 Jul 24.

Authors

Kate Curtis¹, Prabhu Sivabalan², David S Bedford³, Julie Considine⁴, Alfa D'Amato⁵, Nada Shepherd⁶, Tiana Elphick⁷, Ramon Z Shaban⁸, Margaret Fry⁹

Affiliations

¹ Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia; Illawarra Health and Medical Research Institute, Building 32 University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia; George Institute for Global Health, University of NSW, Australia; Faculty of Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia. Electronic address: Kate.Curtis@sydney.edu.au.
² Performance Analysis for Transformation in Healthcare (PATH) Group, University of Technology Sydney, 14-28 Ultimo Road, NSW 2007, Australia. Electronic address: Prabhu.Sivabalan@uts.edu.au.
³ Performance Analysis for Transformation in Healthcare (PATH) Group, University of Technology Sydney, 14-28 Ultimo Road, NSW 2007, Australia. Electronic address: david.bedford@uts.edu.au.
⁴ Deakin University, School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Australia; Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold St, Box Hill, Victoria 3128, Australia. Electronic address: julie.considine@deakin.edu.au.
⁵ Performance Analysis for Transformation in Healthcare (PATH) Group, University of Technology Sydney, 14-28 Ultimo Road, NSW 2007, Australia; System Financial Performance, NSW Ministry of Health, North Sydney, NSW, Australia. Electronic address: Alfa.DAmato@health.nsw.gov.au.
⁶ District Management Accounting, Illawarra Shoalhaven Local Health District, King Street, Warrawong, NSW, Australia. Electronic address: Nada.Shepherd@health.nsw.gov.au.
⁷ Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia. Electronic address: Tiana-Lee.Elphick@sydney.edu.au.
⁸ Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW, Australia; Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and the New South Wales Biocontainment Centre, NSW Health, Hawkesbury Road, Westmead, NSW, Australia. Electronic address: ramon.shaban@sydney.edu.au.
⁹ Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia; School of Nursing and Midwifery, University of Technology Sydney, 15 Broadway, Ultimo, NSW, Australia; Research & Practice Development Unit, Northern Sydney Local Health District. Reserve Road, St Leonards, Sydney, NSW, Australia. Electronic address: Margaret.Fry@uts.edu.au.

PMID: 34314776
DOI: 10.1016/j.resuscitation.2021.07.022

Abstract

Aims: This study aimed to quantify the health economic treatment costs of clinical deterioration of patients within 72 h of admission via the emergency department.

Methods: This study was conducted between March 2018 and February 2019 in two hospitals in regional New South Wales, Australia. All patients admitted via the emergency department were screened for clinical deterioration (defined as initiation of a medical emergency team call, cardiac arrest or unplanned admission to Intensive Care Unit) within 72 h through the site clinical deterioration databases. Patient characteristics, including pre-existing conditions, diagnosis and administrative data were collected.

Results: 1600 patients clinically deteriorated within 72 h of hospital admission. Linked treatment cost data were available for 929 (58%) of these patients across 352 Australian Refined Diagnosis Related Groups. The average (standard deviation) treatment costs for patients who deteriorated within 72 h was $26,778 ($34,007) compared to $7727 ($12,547). The average hospital length of stay of the deterioration group was nearly 8 days longer than patients without deterioration. When controlling for length of stay and Australian Refined Diagnosis Related Group codes, the incremental cost per episode of deterioration was $14,134.

Conclusion: Clinical deterioration within 72 h of admission is associated with increased treatment costs irrespective of diagnosis, hospital length of stay and age. Implementation of interventions known to prevent patient deterioration require evaluation.

Keywords: Clinical deterioration; Emergency department; Health care costs; Health economics; Length of stay.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Clinical Deterioration*
Emergency Service, Hospital
Hospitalization
Humans
Inpatients
Length of Stay