Ontwikkeling van een meetinstrument voor zorgvraag/ Measuring the total amount of care needed by surgical patients

Abstract

Objective: The development of an instrument to determine the total demand for medical and nursing care for surgical patients. Background: Hospitals provide care for patients with a variety of diseases, co-morbidities and complications. The amount of care these different patients require is unclear. Considering recent developments such as aging and stagnating growth of the population, it is plausible that the demand for care will increase in the future, while supply diminishes. Therefore, it is important to identify the factors determining the (trends in the) demand for care. Methods: A prospective cohort was used to identify a regression model with deterministic factors for the total demand for care. The possible determining factors investigated were the number of care pathways, surgical intervention, age, gender, the number of co-morbidities, complications and medications administered during admission, American Society of Anaesthesiologists-classification (ASA-classification), body mass index, nutrition status, medical specialism, occurrence of delirium or pressure ulcers, need for patient isolation, admission and discharge type and mortality. The total amount of care required was based on the costs of medical and nursing time and resources that were used. Six surgical wards in a university hospital in the Netherlands participated in the study. Results: In total, 174 surgical patients were included. The instrument to determine the total demand for medical and nursing care includes five factors: medication used during admission, number of complications, number of co morbidity, type of medical specialism and ASA-classification. An average stay on a general surgical ward costs €8454.75. Each step in increasing medication, complications and ASA-classification leads to an increase in total demand for medical and nursing care. Co-morbidity leads to a decrease in this demand. Medical specialism caused a minimal negative effect by changing in specialism. Conclusions: An instrument based on actual clinical costs that predicts the total (costs of) care needed for surgical patients in a university clinic was developed. The input for the instrument can be derived from readily available data in hospital databases. This instrument helps the caregivers to appreciate the amount of care needed by patients on general (surgical) wards and may be used to appreciate any trends in time.