Economic Analysis of Staff Resource Use in High Dependency Care

1. The  Economic Analysis of Staff Resource Use and the Implications for how High Dependency Care should be Defined Raymond Oppong, Kevin Morris, Nicola Holdback, Joanna Coast

2. Aims and objectives • To explore the cost implications of the current HDC classification • To explore the cost implications of the refined HDC classification • To estimate bedside medical and nursing staff cost associated with specific interventions

3. Methods • Data Collection • Medical and nursing staff • Health care assistant (band 2-4), Nurse (band 5-7), Student nurse, Foundation year doctor, Consultant, Registrar and Senior house officer • Investigations • Pediatric critical care minimum dataset(PCCMDS) investigations

4. Methods • Cost • Unit cost were obtained for each staff resource use item • Mean cost per patient was estimated • Costs adjusted to account for 6 hour observation period • Data analysis • Descriptive statistics • Regression analysis • Classification and regression tree analysis

5. RESULTS

6. Medical and nursing cost Table 1: Total Medical and Nursing costs

7. Medical and nursing staff (original definition) Figure 1: Mean Medical and nursing staff across HDC groups over observation period

8. Costs across groups using original HDC basic definition Table 2: Costs using original definition * significantly different 5% level **significantly different 1% level Kruskal Wallis test

9. Nursing and medical staff new definition Figure 2: Medical and nursing staff across HDC groups

10. Costs across groups using revised HDC definition Table 3: Costs using revised definition * significantly different 5% level **significantly different 1% level Kruskal Wallis test

11. Impact of change in HDC definition • 180 (16.4%) patients classified as HDC with original definition • Mean staff cost with original definition= £44.48 • 41 (3.7%) patients classified as HDC with new definition • Mean staff cost with revised definition= £67.82

12. Staff cost across shifts Table 4: Costs by shift type * significantly different 5% level **significantly different 1% level Kruskal Wallis test

13. Staff cost associated with interventions mapped to basic HDC Table 5: Staff cost of interventions associated with basic HDC * significantly different 5% level **significantly different 1% level Mann Whitney test

14. Staff cost associated with interventions mapped to advanced HDC Table 6: Cost of interventions associated with advanced HDC * significantly different 5% level **significantly different 1% level Mann Whitney test

15. Staff cost associated with interventions proposed for basic HDC Table 7: Cost of proposed HDC interventions * significantly different 5% level **significantly different 1% level Mann Whitney test

16. Staff cost associated with non-HDC investigations Table 8: Cost of non-HDC interventions * significantly different 5% level **significantly different 1% level Mann Whitney test

17. Relationship between cost and PCCMDS investigations Table 9: Relationship between total cost and PCCMDS interventions

18. Factors influencing total cost Figure 3: Factors influencing cost

19. Discussion and conclusion • HDC is associated with a higher cost • The new definition of HDC identifies less patients as requiring high dependency care • The patients identified as HDC with the new definition have a higher mean cost than patients identified as such with original definition • Continuous ECG monitoring is the best predictor of cost