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- Title
Critical care nursing service costs: Comparison of the top‐down versus bottom‐up micro‐costing approach in Brazil.
- Authors
Ricci de Araújo, Thamiris; Papathanassoglou, Elizabeth; Gonçalves Menegueti, Mayra; Grespan Bonacim, Carlos Alberto; Lessa do Valle Dallora, Maria Eulália; de Carvalho Jericó, Marli; Basile‐Filho, Anibal; Laus, Ana Maria
- Abstract
Aim: To estimate the nursing service costs using a top‐down micro‐costing approach and to compare it with a bottom‐up micro‐costing approach. Background: Accurate data of nursing cost can contribute to reliable resource management. Method: We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro‐costing analysis was conducted in two stages: a top‐down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom‐up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). Results: The total mean cost by the top‐down approach was US$1,640.4 ± 1,484.2/patient. The bottom‐up approach based on a total mean NAS of 833 ± 776 points (equivalent to 200 ± 86 hr of nursing care) yielded a mean cost of US$1,487.2 ± 1,385.7/patient. In the 268 patients for whom the top‐down approach estimated higher costs than the bottom‐up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top‐down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). Conclusions: The top‐down approach may yield higher estimated ICU costs compared with a NAS‐based bottom‐up approach. Implications for nursing management: These findings can contribute to an evidence‐based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.
- Subjects
BRAZIL; INTENSIVE care units; INTENSIVE care nursing; NURSING; ACCOUNTING; CONFIDENCE intervals; NURSING services; HOSPITAL costs; RETROSPECTIVE studies; T-test (Statistics); COST analysis; DESCRIPTIVE statistics; DATA analysis software; LONGITUDINAL method
- Publication
Journal of Nursing Management, 2021, Vol 29, Issue 6, p1778
- ISSN
0966-0429
- Publication type
Article
- DOI
10.1111/jonm.13313