24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country

Merino-Osorio, Catalina; Velásquez, Margarita María; Reveco, Roberto; Marmolejo, José Ignacio; Fu, Carolina

doi:10.1016/j.vhri.2020.04.006

Cited by 6 publications

(1 citation statement)

References 29 publications

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“…Many of the proposed best practice considerations are supported by previous studies suggesting outcome bene ts including actual or hypothetical cost bene ts, though cost-effectiveness was not studied, e.g., case of multidisciplinary team model [40][41][42]. One systematic review of cost-related impacts from utilizing respiratory therapists to deliver care showed both direct and indirect cost reductions, which were achieved through protocol utilization, specialized expertise, and autonomous decision making [42].…”

Section: Discussionmentioning

confidence: 99%

Interventions to promote cost-effectiveness in adult Intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study

Kansal,

Latour,

See

et al. 2023

Preprint

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Background There is limited evidence to guide interventions that promote cost-effectiveness in adult intensive care units (ICU). The aim of this consensus statement is to identify globally applicable interventions for best ICU practice and provide guidance for judicious use of resources. Methods A three-round modified online Delphi process, using a web-based platform sought consensus from 61 multidisciplinary ICU experts (physicians, nurses, allied health, administrators) from 21 countries. Round 1 was qualitative to ascertain opinions on cost-effectiveness criteria based on four key domains of high-value healthcare (foundational elements; infrastructure fundamentals; care delivery priorities; reliability and feedback). Round 2 was qualitative and quantitative, while round 3 was quantitative to reiterate and establish criteria. Both rounds 2 and 3 utilised a five-point Likert scale for voting. Consensus was considered when > 70% of the experts voted for a proposed intervention. Thereafter, the steering group endorsed interventions that were identified as ‘critical’ by more than 50% of steering group members. These interventions and experts’ comments were summarized as final considerations for best practice. Results At the conclusion of round 3, consensus was obtained on 50 best practice considerations for cost-effectiveness in adult ICU. Finally, the steering group endorsed 9 ‘critical’ best practice considerations. This included adoption of a multidisciplinary ICU model of care, focus on staff training and competency assessment, ongoing quality audits, thus ensuring high quality of critical care services whether within or outside the four walls of ICUs, implementation of a dynamic staff roster, multidisciplinary approach to implementing end-of-life care, early mobilization and promoting international consensus efforts on the Green ICU concept. Conclusions This Delphi study with international experts resulted in 9 consensus statements and best practice considerations promoting cost-effectiveness in adult ICUs. Stakeholders (government bodies, professional societies) must lead the efforts to identify locally applicable specifics while working within these best practice considerations with the available resources.

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