OBJECTIVE To conduct a narrative review on the evolution of intensive care and the cost of intens... more OBJECTIVE To conduct a narrative review on the evolution of intensive care and the cost of intensive care services in Australia. REVIEW METHOD A narrative review using a search of online medical databases and grey literature with keyword verification via Delphi-technique. DATA SOURCES Using Medical Subject Headings and keywords (intensive care, critical care, mechanical ventilation, renal replacement therapy, extracorporeal membrane oxygenation, monitoring, staffing, cost, cost analysis) we searched MEDLINE, PubMed, CINAHL, Embase, Google and Google Scholar. RESULTS The search yielded 30 articles from which we provide a narrative synthesis on the evolving intensive care practice in relation to key service elements and therapies. For the review of costs, we found five relevant publications and noted significant variation in methods used to cost ICU. Notwithstanding the limitations of the methods used to cost all publications reported staffing as the primary cost driver, representing up to 71% of costs. CONCLUSION Intensive care is a highly specialised medical field, which has developed rapidly and plays an increasingly important role in the provision of hospital care. Despite the increasing importance of the specialty and the known resource intensity there is a paucity of data on the cost of providing this service. In Australia, staffing costs consistently represent the majority of costs associated with operating an ICU. This finding should be interpreted cautiously given the variation of methods used to cost ICU services and the limited number of available studies. Developing standardised methods to consistently estimate ICU costs which can be incorporated in research into the cost-effectiveness of alternate practice is an important step to ensuring cost-effective care.
International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua, Jan 29, 2015
To test our hypothesis that hospitals with higher accreditation scores, specifically in infection... more To test our hypothesis that hospitals with higher accreditation scores, specifically in infection control, would be associated with lower Staphylococcus aureus bacteraemia (SAB) rates. A retrospective cohort study. Acute public hospitals (n = 77) in New South Wales, Australia, with reported SAB rates, results from two accreditation surveys and results from at least four hand hygiene audits. We linked three separate data sets comprising SAB rates, accreditation scores and hand hygiene rates. SAB rates were regressed against accreditation scores, hand hygiene audit rates and hospital demographics using a generalized linear model to account for the non-linear nature of our outcome variable. Significant (P < 0.05) findings included the following: SAB rates across all hospitals fell from 1.34 per 10 000 bed days in 2009 to 0.77 per 10 000 bed days in 2012; mean SAB rates in small hospitals (0.62/10 000 bed days) over the study period were lower than those for principal referral hospit...
Australian health review : a publication of the Australian Hospital Association, 1993
This article analyses Medicare payments to doctors, both general practitioners and specialists. A... more This article analyses Medicare payments to doctors, both general practitioners and specialists. Although these payments represented approximately $4.5 billion in 1991-92, there has been little public analysis of the breakdown of these payments to different medical specialties and general practitioners. These payments are just one source of income for many doctors. Information on practice costs is also presented to give an indication of the size of doctors' net incomes. A comparison is also made between doctors' incomes and taxpayers in general.
Australian health review : a publication of the Australian Hospital Association, 1993
A recent report by the Independent Commission Against Corruption (ICAC) in NSW highlighted that s... more A recent report by the Independent Commission Against Corruption (ICAC) in NSW highlighted that some accounting controls for cash handling in public hospitals are inadequate. Given the number of public hospitals in Australia and the amount of cash being handled, it is essential that efficient accounting and auditing systems are established for these activities. This paper examines several major shortcomings in cash-handling methods used by NSW public hospitals and outlines how the system may be improved. The authors are currently developing a national survey to extend this analysis.
Australian health review : a publication of the Australian Hospital Association, 1992
Privatisation is once again back on the Australian political agenda. More significantly, privatis... more Privatisation is once again back on the Australian political agenda. More significantly, privatisation has become an issue in the health care industry, following a proposal by the New South Wales government to privatise a public hospital in Port Macquarie. The main aims of this article are to discuss: the international move towards privatisation, the benefits of privatisation, the problems associated with privatisation in health care, and the potential health care services which could be privatised.
The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator... more The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. A retrospective, longitudinal, multisite comparative survey. Acute public hospitals in New South Wales, Australia. 96 acute hospitals with accreditation survey results from two surveys during 2009-2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010-2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010-2013), with 46.7% of hospitals achieving target complia...
Australian health review: a publication of the …, 1993
This article analyses Medicare payments to doctors, both general practitioners and specialists. A... more This article analyses Medicare payments to doctors, both general practitioners and specialists. Although these payments represented approximately $4.5 billion in 1991-92, there has been little public analysis of the breakdown of these payments to different ...
purpose. To examine factors influencing the severity of soft contact lens (SCL)related microbial... more purpose. To examine factors influencing the severity of soft contact lens (SCL)related microbial keratitis. methods. Cases were detected via surveillance studies in Australia and New Zealand. Factors affecting disease severity (costs, days of symptoms, and 2 or more ...
To assess the costs of hospital accreditation in Australia. Mixed methods design incorporating: s... more To assess the costs of hospital accreditation in Australia. Mixed methods design incorporating: stakeholder analysis; survey design and implementation; activity-based costs analysis; and expert panel review. Acute care hospitals accredited by the Australian Council for Health Care Standards. Six acute public hospitals across four States. Accreditation costs varied from 0.03% to 0.60% of total hospital operating costs per year, averaged across the 4-year accreditation cycle. Relatively higher costs were associated with the surveys years and with smaller facilities. At a national level these costs translate to $A36.83 million, equivalent to 0.1% of acute public hospital recurrent expenditure in the 2012 fiscal year. This is the first time accreditation costs have been independently evaluated across a wide range of hospitals and highlights the additional cost burden for smaller facilities. A better understanding of the costs allows policymakers to assess alternative accreditation and o...
OBJECTIVE To conduct a narrative review on the evolution of intensive care and the cost of intens... more OBJECTIVE To conduct a narrative review on the evolution of intensive care and the cost of intensive care services in Australia. REVIEW METHOD A narrative review using a search of online medical databases and grey literature with keyword verification via Delphi-technique. DATA SOURCES Using Medical Subject Headings and keywords (intensive care, critical care, mechanical ventilation, renal replacement therapy, extracorporeal membrane oxygenation, monitoring, staffing, cost, cost analysis) we searched MEDLINE, PubMed, CINAHL, Embase, Google and Google Scholar. RESULTS The search yielded 30 articles from which we provide a narrative synthesis on the evolving intensive care practice in relation to key service elements and therapies. For the review of costs, we found five relevant publications and noted significant variation in methods used to cost ICU. Notwithstanding the limitations of the methods used to cost all publications reported staffing as the primary cost driver, representing up to 71% of costs. CONCLUSION Intensive care is a highly specialised medical field, which has developed rapidly and plays an increasingly important role in the provision of hospital care. Despite the increasing importance of the specialty and the known resource intensity there is a paucity of data on the cost of providing this service. In Australia, staffing costs consistently represent the majority of costs associated with operating an ICU. This finding should be interpreted cautiously given the variation of methods used to cost ICU services and the limited number of available studies. Developing standardised methods to consistently estimate ICU costs which can be incorporated in research into the cost-effectiveness of alternate practice is an important step to ensuring cost-effective care.
International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua, Jan 29, 2015
To test our hypothesis that hospitals with higher accreditation scores, specifically in infection... more To test our hypothesis that hospitals with higher accreditation scores, specifically in infection control, would be associated with lower Staphylococcus aureus bacteraemia (SAB) rates. A retrospective cohort study. Acute public hospitals (n = 77) in New South Wales, Australia, with reported SAB rates, results from two accreditation surveys and results from at least four hand hygiene audits. We linked three separate data sets comprising SAB rates, accreditation scores and hand hygiene rates. SAB rates were regressed against accreditation scores, hand hygiene audit rates and hospital demographics using a generalized linear model to account for the non-linear nature of our outcome variable. Significant (P < 0.05) findings included the following: SAB rates across all hospitals fell from 1.34 per 10 000 bed days in 2009 to 0.77 per 10 000 bed days in 2012; mean SAB rates in small hospitals (0.62/10 000 bed days) over the study period were lower than those for principal referral hospit...
Australian health review : a publication of the Australian Hospital Association, 1993
This article analyses Medicare payments to doctors, both general practitioners and specialists. A... more This article analyses Medicare payments to doctors, both general practitioners and specialists. Although these payments represented approximately $4.5 billion in 1991-92, there has been little public analysis of the breakdown of these payments to different medical specialties and general practitioners. These payments are just one source of income for many doctors. Information on practice costs is also presented to give an indication of the size of doctors' net incomes. A comparison is also made between doctors' incomes and taxpayers in general.
Australian health review : a publication of the Australian Hospital Association, 1993
A recent report by the Independent Commission Against Corruption (ICAC) in NSW highlighted that s... more A recent report by the Independent Commission Against Corruption (ICAC) in NSW highlighted that some accounting controls for cash handling in public hospitals are inadequate. Given the number of public hospitals in Australia and the amount of cash being handled, it is essential that efficient accounting and auditing systems are established for these activities. This paper examines several major shortcomings in cash-handling methods used by NSW public hospitals and outlines how the system may be improved. The authors are currently developing a national survey to extend this analysis.
Australian health review : a publication of the Australian Hospital Association, 1992
Privatisation is once again back on the Australian political agenda. More significantly, privatis... more Privatisation is once again back on the Australian political agenda. More significantly, privatisation has become an issue in the health care industry, following a proposal by the New South Wales government to privatise a public hospital in Port Macquarie. The main aims of this article are to discuss: the international move towards privatisation, the benefits of privatisation, the problems associated with privatisation in health care, and the potential health care services which could be privatised.
The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator... more The study aims are twofold. First, to investigate the suitability of hand hygiene as an indicator of accreditation outcomes and, second, to test the hypothesis that hospitals with better accreditation outcomes achieve higher hand hygiene compliance rates. A retrospective, longitudinal, multisite comparative survey. Acute public hospitals in New South Wales, Australia. 96 acute hospitals with accreditation survey results from two surveys during 2009-2012 and submitted data for more than four hand hygiene audits between 2010 and 2013. Our primary outcome comprised observational hand hygiene compliance data from eight audits during 2010-2013. The explanatory variables in our multilevel regression model included: accreditation outcomes and scores for the infection control standard; timing of the surveys; and hospital size and activity. Average hand hygiene compliance rates increased from 67.7% to 80.3% during the study period (2010-2013), with 46.7% of hospitals achieving target complia...
Australian health review: a publication of the …, 1993
This article analyses Medicare payments to doctors, both general practitioners and specialists. A... more This article analyses Medicare payments to doctors, both general practitioners and specialists. Although these payments represented approximately $4.5 billion in 1991-92, there has been little public analysis of the breakdown of these payments to different ...
purpose. To examine factors influencing the severity of soft contact lens (SCL)related microbial... more purpose. To examine factors influencing the severity of soft contact lens (SCL)related microbial keratitis. methods. Cases were detected via surveillance studies in Australia and New Zealand. Factors affecting disease severity (costs, days of symptoms, and 2 or more ...
To assess the costs of hospital accreditation in Australia. Mixed methods design incorporating: s... more To assess the costs of hospital accreditation in Australia. Mixed methods design incorporating: stakeholder analysis; survey design and implementation; activity-based costs analysis; and expert panel review. Acute care hospitals accredited by the Australian Council for Health Care Standards. Six acute public hospitals across four States. Accreditation costs varied from 0.03% to 0.60% of total hospital operating costs per year, averaged across the 4-year accreditation cycle. Relatively higher costs were associated with the surveys years and with smaller facilities. At a national level these costs translate to $A36.83 million, equivalent to 0.1% of acute public hospital recurrent expenditure in the 2012 fiscal year. This is the first time accreditation costs have been independently evaluated across a wide range of hospitals and highlights the additional cost burden for smaller facilities. A better understanding of the costs allows policymakers to assess alternative accreditation and o...
Uploads