Cost-effective use of microcomputers for quality assurance and resource utilization in the surgical intensive care unit

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Abstract
Need for organ system support, severity of illness, and the risk of life-threatening complications are major factors in determining the need for ICU care and directly affect ICU costs. Using a microcomputer and a relational database program, an ICU database was developed to study ICU utilization. The following information was collected for each ICU patient on admission, then daily, and on ICU discharge: demographic data, procedures, monitors used, laboratory tests, complications, outcome, and Acute Physiology and Chronic Health Evaluation (APACHE II) score as a measure of acuity. In our study, this information was used as a first step in an attempt to define categories of patients who might benefit most from intensive care and those who would not. From September 1, 1987 to March 1, 1989, 1,062 patients were admitted to the surgical ICU (SICU). Otorhinolaryngology (ENT) patients with major head and neck resections, routinely admitted to the SICU, were compared with those from other surgical services. The ENT patients had the lowest mean admission APACHE II (6.8 ± 0.4 vs. 11.4 ± 0.3), lowest mean daily APACHE II (7.8 ± 0.4 vs. 13.2 ± 0.1), lowest percent of ventilated patients (7.6% vs. 39.4%) and ventilator days (18.97c vs. 64.6%), and had the least monitoring by central venous catheters (20.9% vs. 57.1%) or pulmonary artery catheters (0.9% vs. 29.8%) (p < .0001 for all of above). They also had the shortest mean ICU stay (1.2 ± 0.1 vs. 3.3 ± 0.2 days, p < .05). The only complication in 105 ENT patients was one uncomplicated myocardial infarction. There were no deaths. The database thus identified a group of patients with low severity of illness, limited need for organ system support, virtually no complications, and no mortality. In the face of limited resources and escalating medical costs, this type of information can be useful in identifying groups of patients for whom routine ICU admission might be reconsidered. A system for cost containment and resource utilization using a microcomputer-based ICU database is recommended, as it can assist in effective use of resources.

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