The costs of caring for patients in a tertiary referral Australian intensive care unit

We determined the direct cost of an Intensive Care Unit (ICU) bed in a tertiary referral Australian ICU and the cost drivers thereof, by retrospectively analysing a number of prospectively designed Hospital- and Unit-specific electronic databases. The study period was a financial year, from 1 July 2002 to 30 June 2003. There were 1615 patients occupying 5692 fractional occupied bed days at a total cost of A$15,915,964, with an average length of stay of 3.69 days (range 0.5-77, median 1.06, interquartile range 2.33). The main cost driver not incorporated into this analysis was blood products (paid for centrally). The average costs of an ICU day and total stay per patient were A$2670 and A$9852 respectively. Staff-related charges were 68.76%, with consumables related expenditure making up 19.65%, clinical support services 9.55% and capital equipment 2.04%. Overtime charges and nursing agency staff were 19.4% of staff-related charges (2.9% for agency staff), 3.9% lower than expenditure associated with full-time employment charges, such as pension and leave. The emergency nature of ICU means it is difficult to accurately set a nursing establishment to cater for all admissions and therefore it is hard to decide what is an acceptable percentage difference between agency/overtime costs compared with the costs associated with full-time staff appointments. Consumable expenditure is likely to increase the most with new innovation and therapies. Using protocol driven practices may tighten and control costs incurred in ICU.

Modelling the conversion of Colombian lowland ecosystems since 1940: Drivers, patterns and rates

In biologically mega-diverse countries that are undergoing rapid human landscape transformation, it is important to understand and model the patterns of land cover change. This problem is particularly acute in Colombia, where lowland forests are being rapidly cleared for cropping and ranching. We apply a conceptual model with a nested set of a priori predictions to analyse the spatial and temporal patterns of land cover change for six 50-100 km(2) case study areas in lowland ecosystems of Colombia. Our analysis included soil fertility, a cost-distance function, and neighbourhood of forest and secondary vegetation cover as independent variables. Deforestation and forest regrowth are tested using logistic regression analysis and an information criterion approach to rank the models and predictor variables. The results show that: (a) overall the process of deforestation is better predicted by the full model containing all variables, while for regrowth the model containing only the auto-correlated neighbourhood terms is a better predictor; (b) overall consistent patterns emerge, although there are variations across regions and time; and (c) during the transformation process, both the order of importance and significance of the drivers change. Forest cover follows a consistent logistic decline pattern across regions, with introduced pastures being the major replacement land cover type. Forest stabilizes at 2-10% of the original cover, with an average patch size of 15.4 (+/- 9.2) ha. We discuss the implications of the observed patterns and rates of land cover change for conservation planning in countries with high rates of deforestation. (c) 2005 Elsevier Ltd. All rights reserved.