A. Schleppers

Kosten der intensivmedizinischen Versorgung in einem deutschen Krankenhaus

OBJECTIVE The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed. METHODS On the ICU of a German focused-care hospital (896 beds, 12 anesthesiology ICU beds), cost per treatment day was calculated with or without mechanical ventilation from the perspective of the hospital. Costs were derived retrospectively with respect to the period between January and October 2006 by cost-unit accounting based on routine data collected from the ICU patients. Patients with a length of stay of at least 2 days on the ICU were included. Demographic, clinical and economical data were analyzed for patient characterization. RESULTS Data of 407 patients (217 male and 190 female) were included in the analysis, of which 159 patients (100 male, 59 female) were completely or partially mechanically ventilated. The mean simplified acute physiology (SAPS) II score at the onset of ICU stay was 28.2. Average cost per ICU day was 1,265 EUR and costs for ICU days with and without mechanical ventilation amounted to 1,426 EUR and 1,145 EUR, respectively. Personnel costs (50%) showed the largest cost share followed by drugs plus medicinal products (18%) and infrastructure (16%). CONCLUSIONS For the first time, a cost analysis of intensive care in Germany was performed with routine data based on the matrix of the institute for reimbursement in hospitals (InEK). The results revealed a higher resource use on the ICU than previously expected. The large share of personnel costs on the ICU was evident but is comparable to other medical departments in the hospital. The need for mechanical ventilation increases the daily costs of resources by approximately 25%.

[Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix].

OBJECTIVE The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed. METHODS On the ICU of a German focused-care hospital (896 beds, 12 anesthesiology ICU beds), cost per treatment day was calculated with or without mechanical ventilation from the perspective of the hospital. Costs were derived retrospectively with respect to the period between January and October 2006 by cost-unit accounting based on routine data collected from the ICU patients. Patients with a length of stay of at least 2 days on the ICU were included. Demographic, clinical and economical data were analyzed for patient characterization. RESULTS Data of 407 patients (217 male and 190 female) were included in the analysis, of which 159 patients (100 male, 59 female) were completely or partially mechanically ventilated. The mean simplified acute physiology (SAPS) II score at the onset of ICU stay was 28.2. Average cost per ICU day was 1,265 EUR and costs for ICU days with and without mechanical ventilation amounted to 1,426 EUR and 1,145 EUR, respectively. Personnel costs (50%) showed the largest cost share followed by drugs plus medicinal products (18%) and infrastructure (16%). CONCLUSIONS For the first time, a cost analysis of intensive care in Germany was performed with routine data based on the matrix of the institute for reimbursement in hospitals (InEK). The results revealed a higher resource use on the ICU than previously expected. The large share of personnel costs on the ICU was evident but is comparable to other medical departments in the hospital. The need for mechanical ventilation increases the daily costs of resources by approximately 25%.

Status quo and current trends of operating room management in Germany.

Purpose of review Ongoing healthcare reforms in Germany have required strenuous efforts to adapt hospital and operating room organizations to the needs of patients, new technological developments, and social and economic demands. This review addresses the major developments in German operating room management research and current practice. Recent findings The introduction of the diagnosis-related group system in 2003 has changed the incentive structure of German hospitals to redesign their operating room units. The role of operating room managers has been gradually changing in hospitals in response to the change in the reimbursement system. Operating room managers are today specifically qualified and increasingly externally hired staff. They are more and more empowered with authority to plan and control operating rooms as profit centers. For measuring performance, common perioperative performance indicators are still scarcely implemented in German hospitals. In 2008, a concerted time glossary was established to enable consistent monitoring of operating room performance with generally accepted process indicators. These key performance indicators are a consistent way to make a procedure or case – and also the effectiveness of the operating room management – more transparent. Summary In the presence of increasing financial pressure, a hospitals executives need to empower an independent operating room management function to achieve the hospitals economic goals. Operating room managers need to adopt evidence-based methods also from other scientific fields, for example management science and information technology, to further sustain operating room performance.

Simulationsbasierte Analyse neuer Therapieprinzipien

ZusammenfassungHintergrundDie Einführung innovativer Medikamente in der anästhesiologischen Behandlung birgt das Potenzial, perioperative Effizienzverbesserungen zu ermöglichen. Der vorliegende Beitrag untersucht die Auswirkungen der Einführung des neuen Muskelrelaxansenkapsulators Bridion in der Anästhesieausleitung auf die Leistungsfähigkeit der perioperativen Ablauforganisation.Material und MethodenZur Analyse der Auswirkungen medizinischer Innovationen wird die computergestützte Simulation als Untersuchungsmethode herangezogen. Die Simulation zeigt die Wirkungsweise von Innovationen auf die operationelle Leistungsfähigkeit sowie die entsprechenden betriebswirtschaftlichen Effekte anhand eines realitätsnahen OP-Modells und historischem Patientendatenkollektiv.ErgebnisseDer Einsatz medizinischer Innovationen in der Anästhesieausleitung kann unter bestimmten Bedingungen Ertragspotenziale für das Krankenhaus realisieren. Aufgrund kürzerer Säulenzeiten und Anästhesiepräsenzzeiten wird zusätzliches Leistungspotenzial für den OP-Bereich freigesetzt. Hieraus resultieren zusätzliche Fallzahlen im gleichen Arbeits- und Abrechnungszeitraum bis zu 2,4%.SchlussfolgerungDie Einführung innovativer Arzneimittel kann unter bestimmten Bedingungen (Verbreitungsgrad der Anwendung, Organisation des OP-Bereichs bzw. des Krankenhauses) zusätzliche leistungs- und betriebswirtschaftliche Potenziale wecken. Auf Basis der anästhesiologisch kontrollierten Zeit kann a priori keine allgemeingültige Aussage über die ökonomischen Potenziale getroffen werden. Zukünftige empirische Studien sollten die Auswirkungen auf Qualität und betriebswirtschaftlichen Nutzen für den gesamten Behandlungspfad untersuchen.AbstractBackgroundThe introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization.MethodsTo analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes.ResultsThe use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods.ConclusionThe introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patient’s portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.BACKGROUND The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization. METHODS To analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes. RESULTS The use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods. CONCLUSION The introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patients portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.

Controlling und Berichtswesen im OP-Management

The operating room (OR) is one of the most expensive facilities in most hospitals. The demands on a professional and process-oriented controlling and reporting in the OR are increased due to the increasingly more limited financial margins at the end of the diagnosis related groups (DRG) convergence phase. This study gives an overview of the current situation for cost calculation, controlling and reporting in OR management in German hospitals in 2007. The data from 69 hospitals were evaluated and this represents the largest currently available data pool on this topic.

[Simulation-based analysis of novel therapy principles. Effects on the efficiency of operating room processes].

ZusammenfassungHintergrundDie Einführung innovativer Medikamente in der anästhesiologischen Behandlung birgt das Potenzial, perioperative Effizienzverbesserungen zu ermöglichen. Der vorliegende Beitrag untersucht die Auswirkungen der Einführung des neuen Muskelrelaxansenkapsulators Bridion in der Anästhesieausleitung auf die Leistungsfähigkeit der perioperativen Ablauforganisation.Material und MethodenZur Analyse der Auswirkungen medizinischer Innovationen wird die computergestützte Simulation als Untersuchungsmethode herangezogen. Die Simulation zeigt die Wirkungsweise von Innovationen auf die operationelle Leistungsfähigkeit sowie die entsprechenden betriebswirtschaftlichen Effekte anhand eines realitätsnahen OP-Modells und historischem Patientendatenkollektiv.ErgebnisseDer Einsatz medizinischer Innovationen in der Anästhesieausleitung kann unter bestimmten Bedingungen Ertragspotenziale für das Krankenhaus realisieren. Aufgrund kürzerer Säulenzeiten und Anästhesiepräsenzzeiten wird zusätzliches Leistungspotenzial für den OP-Bereich freigesetzt. Hieraus resultieren zusätzliche Fallzahlen im gleichen Arbeits- und Abrechnungszeitraum bis zu 2,4%.SchlussfolgerungDie Einführung innovativer Arzneimittel kann unter bestimmten Bedingungen (Verbreitungsgrad der Anwendung, Organisation des OP-Bereichs bzw. des Krankenhauses) zusätzliche leistungs- und betriebswirtschaftliche Potenziale wecken. Auf Basis der anästhesiologisch kontrollierten Zeit kann a priori keine allgemeingültige Aussage über die ökonomischen Potenziale getroffen werden. Zukünftige empirische Studien sollten die Auswirkungen auf Qualität und betriebswirtschaftlichen Nutzen für den gesamten Behandlungspfad untersuchen.AbstractBackgroundThe introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization.MethodsTo analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes.ResultsThe use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods.ConclusionThe introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patient’s portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.BACKGROUND The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization. METHODS To analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes. RESULTS The use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods. CONCLUSION The introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patients portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.

[Controlling and reporting in operating room management: analysis of the state of development].

The operating room (OR) is one of the most expensive facilities in most hospitals. The demands on a professional and process-oriented controlling and reporting in the OR are increased due to the increasingly more limited financial margins at the end of the diagnosis related groups (DRG) convergence phase. This study gives an overview of the current situation for cost calculation, controlling and reporting in OR management in German hospitals in 2007. The data from 69 hospitals were evaluated and this represents the largest currently available data pool on this topic.

Simulationsbasierte Analyse neuer Therapieprinzipien@@@Simulation-based analysis of novel therapy principles: Auswirkungen auf die Leistungsfähigkeit der OP-Prozesse@@@Effects on the efficiency of operating room processes

ZusammenfassungHintergrundDie Einführung innovativer Medikamente in der anästhesiologischen Behandlung birgt das Potenzial, perioperative Effizienzverbesserungen zu ermöglichen. Der vorliegende Beitrag untersucht die Auswirkungen der Einführung des neuen Muskelrelaxansenkapsulators Bridion in der Anästhesieausleitung auf die Leistungsfähigkeit der perioperativen Ablauforganisation.Material und MethodenZur Analyse der Auswirkungen medizinischer Innovationen wird die computergestützte Simulation als Untersuchungsmethode herangezogen. Die Simulation zeigt die Wirkungsweise von Innovationen auf die operationelle Leistungsfähigkeit sowie die entsprechenden betriebswirtschaftlichen Effekte anhand eines realitätsnahen OP-Modells und historischem Patientendatenkollektiv.ErgebnisseDer Einsatz medizinischer Innovationen in der Anästhesieausleitung kann unter bestimmten Bedingungen Ertragspotenziale für das Krankenhaus realisieren. Aufgrund kürzerer Säulenzeiten und Anästhesiepräsenzzeiten wird zusätzliches Leistungspotenzial für den OP-Bereich freigesetzt. Hieraus resultieren zusätzliche Fallzahlen im gleichen Arbeits- und Abrechnungszeitraum bis zu 2,4%.SchlussfolgerungDie Einführung innovativer Arzneimittel kann unter bestimmten Bedingungen (Verbreitungsgrad der Anwendung, Organisation des OP-Bereichs bzw. des Krankenhauses) zusätzliche leistungs- und betriebswirtschaftliche Potenziale wecken. Auf Basis der anästhesiologisch kontrollierten Zeit kann a priori keine allgemeingültige Aussage über die ökonomischen Potenziale getroffen werden. Zukünftige empirische Studien sollten die Auswirkungen auf Qualität und betriebswirtschaftlichen Nutzen für den gesamten Behandlungspfad untersuchen.AbstractBackgroundThe introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization.MethodsTo analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes.ResultsThe use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods.ConclusionThe introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patient’s portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.BACKGROUND The introduction of innovative drugs in anesthesiological treatment has the potential to improve perioperative efficiency. This article examines the impact of the new muscle relaxant encapsulator Bridion on emergence from anesthesia and on the efficiency of the perioperative organization. METHODS To analyze the effects of medical innovations, computer simulation was used as an experimental frame. The simulation was based on a realistic model of an operating room setting and used historical data to study the effect of innovation on the operational performance and the economic outcomes. RESULTS The use of medical innovations in anesthesiological emergence yields new potentials for a hospital under certain conditions. Due to shorter block times and anesthesia-controlled times, additional benefits for the operating room could be realized. This results in an increase of up to 2.4% additional cases during similar working hours and planning periods. CONCLUSION The introduction of innovative medicines may reveal more efficient and economical conditions in operating rooms. The overall result depends, for example, on the rate of application of the patients portfolio or the organization and access rules of the surgical suite. Based on the anesthesia-controlled time no general a priori statement about the economic potentials can be confirmed. Future empirical studies should investigate the impact on quality and economic benefits for the entire patient pathway.

Controlling und Berichtswesen im OP-Management@@@Controlling and reporting in operating room management: Analyse des Entwicklungsstands@@@Analysis of the state of development

The operating room (OR) is one of the most expensive facilities in most hospitals. The demands on a professional and process-oriented controlling and reporting in the OR are increased due to the increasingly more limited financial margins at the end of the diagnosis related groups (DRG) convergence phase. This study gives an overview of the current situation for cost calculation, controlling and reporting in OR management in German hospitals in 2007. The data from 69 hospitals were evaluated and this represents the largest currently available data pool on this topic.

Kosten der intensivmedizinischen Versorgung in einem deutschen Krankenhaus@@@Cost of intensive care in a German hospital: Kostenträgerstückrechnung basierend auf der InEK-Matrix@@@Cost-unit accounting based on the InEK matrix

OBJECTIVE The aim of this study was to determine the actual cost per intensive care unit (ICU) day in Germany based on routine data from an electronic patient data management system as well as analysis of cost-driving factors. A differentiation between days with and without mechanical ventilation was performed. METHODS On the ICU of a German focused-care hospital (896 beds, 12 anesthesiology ICU beds), cost per treatment day was calculated with or without mechanical ventilation from the perspective of the hospital. Costs were derived retrospectively with respect to the period between January and October 2006 by cost-unit accounting based on routine data collected from the ICU patients. Patients with a length of stay of at least 2 days on the ICU were included. Demographic, clinical and economical data were analyzed for patient characterization. RESULTS Data of 407 patients (217 male and 190 female) were included in the analysis, of which 159 patients (100 male, 59 female) were completely or partially mechanically ventilated. The mean simplified acute physiology (SAPS) II score at the onset of ICU stay was 28.2. Average cost per ICU day was 1,265 EUR and costs for ICU days with and without mechanical ventilation amounted to 1,426 EUR and 1,145 EUR, respectively. Personnel costs (50%) showed the largest cost share followed by drugs plus medicinal products (18%) and infrastructure (16%). CONCLUSIONS For the first time, a cost analysis of intensive care in Germany was performed with routine data based on the matrix of the institute for reimbursement in hospitals (InEK). The results revealed a higher resource use on the ICU than previously expected. The large share of personnel costs on the ICU was evident but is comparable to other medical departments in the hospital. The need for mechanical ventilation increases the daily costs of resources by approximately 25%.