Critical care nursing service costs: Comparison of the top-down versus bottom-up micro-costing approach in Brazil.

AIM: To estimate the nursing service costs using a top-down micro-costing approach and to compare it with a bottom-up micro-costing approach. BACKGROUND: Accurate data of nursing cost can contribute to reliable resource management. METHOD: We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro-costing analysis was conducted in two stages: a top-down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom-up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). RESULTS: The total mean cost by the top-down approach was US$1,640.4 ± 1,484.2/patient. The bottom-up approach based on a total mean NAS of 833 ± 776 points (equivalent to 200 ± 86 hr of nursing care) yielded a mean cost of US$1,487.2 ± 1,385.7/patient. In the 268 patients for whom the top-down approach estimated higher costs than the bottom-up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top-down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). CONCLUSIONS: The top-down approach may yield higher estimated ICU costs compared with a NAS-based bottom-up approach. IMPLICATIONS FOR NURSING MANAGEMENT: These findings can contribute to an evidence-based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.

Urgent need for standardised guidelines for reporting healthcare costs in ICUs - Results of an integrative review of costing methodologies.

OBJECTIVES: Diverse costing methodologies in critical care have produced discrepant results. We aimed to critically review studies addressing critical care patients' costs, to estimate total costs and cost categories and to delineate methodologies used and relevant limitations. METHODS: Integrative review based on key-word searches of electronic databases targeting primary studies that report estimates of patient cost, in the last 21 years. We assessed the level transparency of reporting and the quality of the studies, by the SIGN tool. RESULTS: Overall, 12 research articles were included, of which eight studies mentioned the specific approach used to identify the elements of cost. Most studies employed a micro-costing and one study a macro-costing approach. With regard to approaches to valuation of cost components, only one study identified the bottom-up approach. The total patient cost ranged from US$ 487 to US$ 39,300 and human resources was identified as the cost category mostly driving total costs. CONCLUSIONS: Although valid methodologies to evaluate critical care patients' costs, such as micro-costing, are employed more frequently, a variety of non-standardized methods are still used. There is a pressing need to develop standardised guidelines for reporting of observational studies of cost in healthcare, with particular considerations for critical care.

Fatores associados à carga de trabalho de enfermagem em unidade de terapia intensiva: revisão integrativa / Factores asociados con la carga de trabajo de enfermería en la unidad de cuidados intensivos: revisión integradora / Factors associated with nursing workload in the intensive care units: integrative review

RESUMO Objetivo: Identificar as evidências disponíveis na literatura nacional e internacional sobre fatores associados à carga de trabalho de enfermagem em Unidade de Terapia Intensiva. Método: Trata-se de uma Revisão Integra tiva da Literatura realizada no período de janeiro de 2003 a dezembro de 2013. O levantamento dos estudos foi realizado nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde e Medical Literature Analysis and Retrieval System Online. Resultados: A amostra final consistiu de 16 artigos. A análise evidenciou que as variáveis que mais foram citadas como preditoras de maior carga de trabalho em Unidade de Terapia Intensiva foram o tempo de permanência na unidade, gravidade e desfecho. A idade do paciente não teve impacto na carga de trabalho na maioria dos estudos. Conclusão: Esta revisão possibilitou conhecer as va riáveis que tem sido objeto de investigação enquanto influência sobre carga de trabalho em Unidade de Terapia Intensiva sem, entretanto possibilitar que se afirme tal relação, necessitando novos estudos.

ABSTRACT Objective: This study aimed to evaluate the evidence available in the national and international literature on the factors associated with nursing workload in the Intensive Care Unit. Method: This is an Integrative Literature Review conducted from January 2003 to December 2013. The survey of studies was conducted on the basis of Latin American and Caribbean Literature Data on Health Sciences and Medical Literature Analysis and Retriev al System Online. Results: The final sample consisted of 16 items. The analysis of these showed that the variables that were mosly cited as predictors of increased workload in the Intensive Care Unit were the length of stay in the unit, severity and outcome. Patient age had no impact on the workload in most studies. Conclusion: This review has helped understand the variables that have received attention as influence on nursing workload in the Intensive Care Unit, although such relationship cannot be confirmed therefore further studies are needed.

RESUMEN Objetivo: Identificar la evidencia disponible en la literatura nacional e internacional sobre los factores asociados con la carga de trabajo de enfermería en Unidades de Cuidados Intensivos. Método: Se trata de una revisión integradora de la literatura realizada en el período enero de 2003 a diciembre de 2013. La búsqueda de estudios se realizó en las bases de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud y en Medical Literature Analysis and Retrieval System Online. Resultados: La muestra final estuvo compuesta por 16 artícu los. El análisis mostró que las variables que más se citaron como predictoras de mayor carga de trabajo en las Unidades de Cuidados Intensivos fueron la duración de la estadía en la unidad, la gravedad y el resultado. La edad del paciente no tuvo impacto en la carga de trabajo en la mayoría de los estudios. Conclusión: La revisión permitió conocer las variables que han sido objeto de investigación en relación a la influencia en la carga de trabajo en Unidades de Cuidados Intensivos, pero sin permitir afirmar esta relación, lo que requiere estudios adicionales.