La classification médico-économique SRLF-SFAR-Image est applicable à un service de réanimation polyvalente d'un centre hospitalier général

Summary A lthough the economic aspect of intensive care units is of considerable importance, it is not sufficiently taken into account in the ‘diagnosis related groups’ (DRG) in the current version of the Programme de Medicalisation des Systemes d’Information (PMSI). A medico-economic classification based on organ failure in intensive care patients was set up by the following groups: the Societe de Reanimation de Langue Francaise (SRLF), the Societe Francaise d’Anesthesie-Reanimation (SFAR) and Image. In the case of multi-unit hospitalization, most frequently in intensive care units (ICU), the DRG is nevertheless Inaccurately associated with the surgical department, or the unit in which the duration of hospital stay was the longest; and in the case of a similar length of stay in two departments, the last unit takes precedence regarding the DRG. However, the economic requirements of ICUs are real, and constitute 15 to 20% of the hospital budget for less than 5% beds. Aim: The aim of this study was to apply the current PMSI classification to a retrospective study, i.e., 4,027 consecutive stays (1989–1997) in an 8-bed medico-surgical ICU, and to compare this with the 1993–1994 SRLF database. Method: The data on 3,646 of the 4,027 consecutive stays was divided into 16 groups, as defined by SFAR-SRLF-Image. The parameters for the database were those outlined in the PMSI, gravity index (Simplified Acute Physiologic Score, SAPS, with SAPS I prior to 1996 converted to SAPS II, and with SAPS II after January 1st 1997), omega score, organ failure procedures noted on a dally basis, and diagnostic information based on CIM 9 1989–1995) and CIM 10 (after January 1st 1997), These findings were then compared to those from the SRLF database. Results: All patients were included in the 16 groups, and a descriptive and a comparative analysis were made of the data. The classification explained 66% of the ICU workload (omega score) and 52% of the duration of stay. Fourteen groups out of 16 had an orrega coefficent of variation of less than 1. The main differences between the retrospective study database and that of the SRLF were the patient distribution within; groups, length of hospital stay and a 30–40% lower omega score for those groups with long duration of hospitalization. Conclusion: The medico-economic SRLF-SFAR-image classification that has been proposed can be easily applied to the database of a short-stay 400-bed ICU, It is simple to use and aims at providing an economic evaluation of the hospital stay. The differences noted between the two databases could be due to structural and study population recrultment differences, and should be further reassessed via a prospective multicenter study, including hospitals of different sizes.