PEDIATRIC CRITICAL CARE COST CONTAINMENT - COMBINED ACTUARIAL AND CLINICAL-PROGRAM

Objective: To determine if providing patients' daily survival probabilities to physicians and nurses along with a short videotape on the measurement of survival probabilities and costs of pediatric intensive care would reduce resource use. Design: Prospective, randomized, controlled trial. Setting: Pediatric ICU. Patients: Medical patients in a prospective control period (n = 113), an intervention period (n = 226), and a follow-up control period (n = 97). Interventions: The survival probabilities of 50% of the patients in the intervention period were displayed at the bedside and the staff viewed a short videotape on the measurement of survival probabilities and costs of pediatric intensive care. Measurements and Main Results: Daily survival probabilities and resource use were evaluated each day. Resource use, adjusted for severity of illness, was evaluated using analysis of covariance. Compared with the prospective control group, reductions in the daily use of blood gases (p < .01), hematology tests (p < .001), hourly vital signs (p < .001), and hourly neurologic vital signs (p < .001) resulting in a composite reduction in daily laboratory and imaging charges from $759 +/- $22 to $622 +/- $18 (p < .01) were observed in the patient group receiving the survival probabilities and whose physicians also viewed the videotape. Equivalent reductions in resource use also occurred in a simultaneous control group (patients did not receive survival probabilities but healthcare workers did view the videotape) and in a follow-up control group. Conclusions: Reduction in pediatric intensive care resource use can occur from the combined effects of actuarial and clinical interventions.