Decrease in costs for management of lower airway disease in the pediatric intensive care unit.

Abstract

BACKGROUND: We investigated whether a recently restructured pediatric intensive care unit (PICU) had a decrease in the cost of patient care over the years. METHODS: We retrospectively studied 89 previously healthy patients admitted to the PICU of a community-based, university-affiliated teaching hospital over a 4-year period (1991 to 1994) for treatment of lower airway disease. Data collected were patient age, severity of illness, length of stay in both PICU and hospital, prorated hospital bill, year of admission, and patient-specific PICU-originated costs (POC). RESULTS: There was a decrease of POC over the 4-year period, though two factors were associated with a cost increase in this group of patients: an increase in the severity of illness and intubation. The decrease over the years remained present even when excluding intubated patients and adjusting for severity of illness. A decline of 58% below the initial cost for diagnostic tests was the most prominent of all the individual areas studied. Decreases in POC correlated with decreases in the prorated hospital bill. CONCLUSIONS: The costs of management for these previously healthy patients treated for lower airway disease decreased over the study period. We speculate that the time related decrease in costs is a reflection of the learning curve of the pediatric critical care team. The decrease in POC did not shift costs to other areas of the hospital.