Program on high value cost-conscious education in Intensive Care:
Educational program on prediction of outcome and cost awareness on Intensive Care admission
Background: Intensive Care (ICU) involves extended and long lasting support of vital functions and organs. However, current training programs of ICU residents mainly focus on extended support of vital functions and barely involve training on cost-awareness and outcome. We incorporated an educational program on high-value cost-conscious care for residents and fellows on our ICU and measured the effect of education.
Methods: A cohort study with factorial survey design, in which ICU residents and fellows were asked to evaluate clinical vignettes, was performed on the mixed surgical-medical ICU of the Amsterdam University Medical Centre. Residents were offered an educational program focusing on outcome and costs of ICU care. Before and after the program they filled out a questionnaire, which consisted of 23 vignettes, in which known predictors of outcome of community acquired pneumonia (CAP), pancreatitis, acute respiratory distress syndrome (ARDS) and cardiac arrest were presented, together with varying patient factors (age, body mass index (BMI), acute kidney failure (AKI) and haemato-oncological malignancy). Participants were asked to either admit the patient or estimate mortality.
Results: BMI, haemato-oncological malignancy and severity of pancreatitis were discriminative for admission to ICU in clinical vignettes on pancreatitis and CAP. After education, only severity of pancreatitis was judged as discriminative. Before the intervention only location of cardiac arrest (in- vs out of hospital) was distinctive for mortality, afterwards this changed to presence of haemato-oncological malignancy.
Conclusion: We incorporated an educational program on high-value cost-conscious care in the training of ICU physicians. Based on our vignette study, we conclude that the improvement of knowledge of costs and prognosis after this program was limited.
Figure 1
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Posted 30 May, 2020
On 21 May, 2020
On 20 May, 2020
On 20 May, 2020
Received 02 May, 2020
On 02 May, 2020
Received 10 Feb, 2020
On 06 Feb, 2020
On 06 Feb, 2020
Invitations sent on 24 Jan, 2020
On 23 Jan, 2020
On 22 Jan, 2020
On 22 Jan, 2020
On 06 Jan, 2020
On 06 Jan, 2020
On 31 Dec, 2019
On 31 Dec, 2019
On 25 Dec, 2019
Program on high value cost-conscious education in Intensive Care:
Educational program on prediction of outcome and cost awareness on Intensive Care admission
Posted 30 May, 2020
On 21 May, 2020
On 20 May, 2020
On 20 May, 2020
Received 02 May, 2020
On 02 May, 2020
Received 10 Feb, 2020
On 06 Feb, 2020
On 06 Feb, 2020
Invitations sent on 24 Jan, 2020
On 23 Jan, 2020
On 22 Jan, 2020
On 22 Jan, 2020
On 06 Jan, 2020
On 06 Jan, 2020
On 31 Dec, 2019
On 31 Dec, 2019
On 25 Dec, 2019
Background: Intensive Care (ICU) involves extended and long lasting support of vital functions and organs. However, current training programs of ICU residents mainly focus on extended support of vital functions and barely involve training on cost-awareness and outcome. We incorporated an educational program on high-value cost-conscious care for residents and fellows on our ICU and measured the effect of education.
Methods: A cohort study with factorial survey design, in which ICU residents and fellows were asked to evaluate clinical vignettes, was performed on the mixed surgical-medical ICU of the Amsterdam University Medical Centre. Residents were offered an educational program focusing on outcome and costs of ICU care. Before and after the program they filled out a questionnaire, which consisted of 23 vignettes, in which known predictors of outcome of community acquired pneumonia (CAP), pancreatitis, acute respiratory distress syndrome (ARDS) and cardiac arrest were presented, together with varying patient factors (age, body mass index (BMI), acute kidney failure (AKI) and haemato-oncological malignancy). Participants were asked to either admit the patient or estimate mortality.
Results: BMI, haemato-oncological malignancy and severity of pancreatitis were discriminative for admission to ICU in clinical vignettes on pancreatitis and CAP. After education, only severity of pancreatitis was judged as discriminative. Before the intervention only location of cardiac arrest (in- vs out of hospital) was distinctive for mortality, afterwards this changed to presence of haemato-oncological malignancy.
Conclusion: We incorporated an educational program on high-value cost-conscious care in the training of ICU physicians. Based on our vignette study, we conclude that the improvement of knowledge of costs and prognosis after this program was limited.
Figure 1