Length of stay, amount of care, and case-related treatment costs after process optimization in a German intensive care unit

Background: In 2002 in a German 10-bed intensive care unit (ICU), a comprehensive process optimization (PO) strategy was implemented comprising, inter alia, the sole use of remifentanil/propofol instead of fentanyl/midazolam for the analgosedation of ventilated patients. Purpose: To evaluate the impact of the PO on length of stay, amount of care, and costs per case in the ICU from the point of view of the hospital. Methods: Retrospective analysis of routinely documented data from the ICU prior to (years 2000-2001) and after PO (years 2003-2004). All costs were adjusted to 2004 figures and were compared with data published by other ICUs in the eastern region of Germany. Results: No significant differences were seen in the demographic and clinical variables, including mortality, prior to and after PO. PO resulted in a significant 16 % reduction in the length of stay, 19 % in the amount of care, and 25 % in costs per case. In ventilated patients there was a trend towards a decrease in the duration of mechanical ventilation, length of stay and amount of care, despite the fact that this group was significantly older (63.2 versus 59.3 years) and more severely ill (APACHE-II score 21.6 versus 18.2) after PO than before. Costs per case (2435 (sic)) were already considerably lower than those in comparable ICUs before PO and decreased to 1815 (sic) after PO. Conclusions: PO was successful in decreasing costs with no change in mortality despite the fact that the ventilated patients were more severely ill.