domingo, novembro 18, 2007

Economic Implications of An Evidence-Based Sepsis Protocol

Mais uma idéia sobre o uso de protocolos em medicina intensiva.

Economic Implications of An Evidence-Based Sepsis Protocol: Can We Improve Outcomes and Lower Costs?

Shorr AF, Micek ST, Jackson WL, Kollef MH
Crit Care Med. 2007;35:1257-1262

Severe sepsis and septic shock together comprise a common and lethal disease, occurring in 10% to 25% of all patients in intensive care units, with approximate mortality rates of 40% and 60%, respectively.[1,2] With the recent development of various potential therapies for severe sepsis and septic shock (eg, early goal-directed therapy, recombinant human activated protein C, corticosteroids, glycemic control), a new era has emerged for managing these complex patients. Clinical care is moving toward evidence-based protocols that apply the evidence from these studies[1,2] to optimal patient management. Although prior studies have shown that these protocols, such as those advocated by the Surviving Sepsis Campaign,[3] have salutary effects on survival and organ dysfunction,[4,5] they have not been tested economically. The authors of this study sought to determine whether the application of a severe sepsis management protocol was cost-effective in their institution, a tertiary-care academic hospital. Data were collected before and after implementation of a severe sepsis protocol; outcomes were assessed and hospital costs were estimated. Survival increased after implementation of the protocol (from 52% to 70%) and hospital length of stay was reduced by an average of 5 days. Median total hospital costs per patient were less after the implementation of the sepsis protocol ($16,103 vs $21,985), and remained less even when considering only the survivors.

This study provides an important piece of information for both physicians and institutions to determine how best to optimize the care of patients with severe sepsis. While the true costs of caring for patients with sepsis may vary across institutions, these data suggest that institutions may actually reduce expenditures while saving lives. Many physicians and institutions are already in the process of implementing protocols for the management of these patients, and with the data from this study, even more should be willing to do so. These data may be of most importance for indigent care hospitals where containment of costs is often paramount in order to ensure care for all. At this point, it seems prudent for each hospital to proactively consider how best to manage their sepsis patients, and to strongly consider both the healthcare and financial advantages of protocolized sepsis care.