• H Kern and W J Kox.
• Department of Anesthesiology and Intensive Care, University Hospital Charité, Humboldt-University Berlin, Germany. hartmut.kern@charite.de
• Intensive Care Med. 1999 Dec 1;25(12):1367-73.

ObjectiveTo investigate the impact of organizational procedures on intensive care unit (ICU) performance and cost-effectiveness after cardiac surgery.DesignProspective study.SettingCardiothoracic ICU at a university hospital.PatientsThousand five hundred twenty-six consecutive patients over a period of 18 months.InterventionsThe first 6 months were used as the control period. Afterwards selected organizational changes were introduced, such as written standard procedures, time schedules and discharge reports.MeasurementsDemographic data, surgical procedures, length of ICU and hospital stay and hospital outcome were recorded. Severity of illness was assessed daily using Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II) and Organ Failure Score (OFS). Intensity of treatment and nursing care was monitored by the Therapeutic Intervention Scoring System (TISS). RIYADH ICU Program (RIP 5.0) was used to determine the relationship of observed to predicted mortality (standardized mortality ratio SMR) and the effective costs per survivor.Main ResultsSMR decreased continuously after the establishment of new management procedures while all other factors all other factors remained unchanged. Comparing outcome according to APACHE II on ICU admission demonstrated a significantly increased ICU performance in high risk patients with an APACHE II of 20-30 points (p < 0.05) while effective costs per survivor decreased significantly from DM 29,988 to DM 13,568 DM (p < 0.05).ConclusionsOrganizational changes can improve ICU performance and cost-effectiveness after cardiac surgery. The RIP may be used to monitor the clinical and economical effects of change.

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