eMJA Casemix Supplement: Butt & Shann Box

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Studies of comparative costs of transferred and non-transferred patients

Surgical patients in a New York hospital, 1998²
Hospital care for transferred patients was significantly more costly than that for non-transferred patients within the same surgical DRG.

Mean length of stay (days) Mean cost per patient Mean laboratory costs Mean radiology costs

Transferred
n = 97 21.4 $17 348 $1849 $794

Not transferred
n = 2976 10.9 $9460 $675 $397

Costs are given in US dollars.

Patients in a surgical intensive care unit, Boston, 1991⁵
Transferred patients were significantly more severely ill and their hospital care more costly.

Mortality

APACHE II score < 16 APACHE II score > 19 Cost/patient

Transferred
n = 41 15% 89% $85 987

Not transferred
n = 41 6% 44% $44 392

APACHE II (acute physiology and chronic health evaluation) is a severity of illness score. The higher the score, the more severe the illness.

General surgical Medicare patients in hospital in the United States, 1984-1985³
Hospital care for transferred patients was over 30% more costly than that for patients in the same DRG who were not transferred.

Hospitals received an average of 1.22% (95% confidence interval, 0Ð4.95%) of Medicare patients by transfer
Charges within the same DRG were 37.5% higher for patients transferred between hospitals
Transferred patients accounted for 31.3% of the higher hospital costs

Children in the Intensive Care Unit (ICU) at the Royal Children's Hospital, Melbourne (unpublished)
Children transferred stayed longer in the intensive care unit were more likely to die, and more likely to need to be ventilated.

Mean hours in ICU Died Intubated Ventilated

Transferred
n = 946 (59%) 67 7.0% 76% 68%

Not transferred
n = 645 (41%) 46 5.4% 56% 49%

Transferred/
not transferred 1.46 1.30 1.36 1.39

Children in a paediatric intensive care unit, New York, 1993⁴
The risk of death of transferred patients was almost double that for non-transferred patients; costs were slightly higher and DRG payments slightly lower.

Risk of death (PRISM score) Cost Payment (DRGs) Loss

Transferred
n = 492 (43%) 10.4% $21 941 $9 825 $12 116

Not transferred
n = 645 (57%) 5.3% $19 363 $12 355 $7 007

Transferred/
not transferred 1.96 1.13 0.08 1.73

PRISM = Paediatric risk of mortality.

Royal Children's Hospital Intensive Care Unit (ICU) nurse dependency study - July 1993 (unpublished)
Transferred patients were more likely to consume more nursing resources.

Mean hours in ICU Died Intubated/Ventilated Average no. of nurses per day Total nurse-days

Transferred
n = 55 (81%) 114 9.1% 76%/71% 0.89 4.53

Not transferred
n = 13 (19%) 26 23.1% 46%/31% 0.72 0.08

Transferred/
not transferred 4.38 0.39 1.65/2.29 1.24 5.68

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	Mean length of stay (days)	Mean cost per patient	Mean laboratory costs	Mean radiology costs
Transferred n = 97	21.4	$17 348	$1849	$794
Not transferred n = 2976	10.9	$9460	$675	$397

	Mortality
	APACHE II score < 16	APACHE II score > 19	Cost/patient
Transferred n = 41	15%	89%	$85 987
Not transferred n = 41	6%	44%	$44 392

	Mean hours in ICU	Died	Intubated	Ventilated
Transferred n = 946 (59%)	67	7.0%	76%	68%
Not transferred n = 645 (41%)	46	5.4%	56%	49%
Transferred/ not transferred	1.46	1.30	1.36	1.39

	Risk of death (PRISM score)	Cost	Payment (DRGs)	Loss
Transferred n = 492 (43%)	10.4%	$21 941	$9 825	$12 116
Not transferred n = 645 (57%)	5.3%	$19 363	$12 355	$7 007
Transferred/ not transferred	1.96	1.13	0.08	1.73

	Mean hours in ICU	Died	Intubated/Ventilated	Average no. of nurses per day	Total nurse-days
Transferred n = 55 (81%)	114	9.1%	76%/71%	0.89	4.53
Not transferred n = 13 (19%)	26	23.1%	46%/31%	0.72	0.08
Transferred/ not transferred	4.38	0.39	1.65/2.29	1.24	5.68