A propensity matched cost analysis of medical emergency team calls led by nurse practitioners versus intensive care registrars

Sachin Gupta; Ravindranath Tiruvoipati; Mayurathan Balachandran; Gaby Bolton; Naomi Pratt; Jo Molloy; Eldho Paul; Adam Irving

doi:10.1016/j.iccn.2024.103819

A propensity matched cost analysis of medical emergency team calls led by nurse practitioners versus intensive care registrars

Intensive Crit Care Nurs. 2024 Sep 9:86:103819. doi: 10.1016/j.iccn.2024.103819. Online ahead of print.

Authors

Sachin Gupta¹, Ravindranath Tiruvoipati², Mayurathan Balachandran³, Gaby Bolton³, Naomi Pratt³, Jo Molloy³, Eldho Paul⁴, Adam Irving⁵

Affiliations

¹ Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
² Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia. Electronic address: travindranath@hotmail.com.
³ Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia.
⁴ ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
⁵ Centre for Heath Economics, Monash Business School, Monash University, Caulfield East, VIC 3145, Australia.

PMID: 39255615
DOI: 10.1016/j.iccn.2024.103819

Abstract

Objectives: Nurse practitioner-led MET calls have been shown to improve clinical outcomes versus ICU registrar-led MET calls. However, the cost implications of a nurse practitioner-led MET call system is not known. We conducted cost analysis from the healthcare service perspective to compare the costs of nurse practitioner- and ICU registrar-led MET calls.

Research methodology: A retrospective study of MET calls between 1 June 2016 and 9 March 2018 including patients with first MET call during their hospital admission. The cost analysis compared MET calls attended by nurse practitioners against those attended by ICU registrars.

Main outcome measures: Inpatient costs for nurse practitioner- and ICU registrar-led MET calls.

Results: 1,343 MET calls were included in the full dataset with a mean cost per ICU registrar-led MET calls and nurse practitioner led MET calls of AU$19,836 (95 % CI: AU$15,778 - AU$23,895) versus AU$16,404 (95 % CI: AU$14,988 - AU$17,820) respectively and a difference of AU$3,432 (95 % CI: -AU$38 - AU$6,903, p = 0.053). In the propensity-score matched analysis, the mean cost per ICU registrar-led MET calls and nurse practitioner led MET calls was AU$19,009 (95 % CI: AU$15,439 - AU$22,578) and AU$13,937 (95 % CI: AU$12,038 - AU$15,835) respectively, with a difference of AU$5,072 (95 % CI: AU$1,061 - AU$9,082, p = 0.013). A 24-hour nurse practitioners-led MET call service would break even at 101 MET calls leading to ICU admissions per year.

Conclusion: Nurse practitioners-led MET calls saved significant costs compared to ICU registrar-led MET calls. Assuming that the difference in costs is due to shorter ICU length of stay, a health service that receives more than 101 MET calls leading to ICU admissions per year can save costs with a 24-hour nurse practitioner-led MET call service.

Implications for clinical practice: This study helps in identifying the healthcare services where nurse practitioners -led MET systems could be implemented to be cost saving from health service perspective.

Keywords: Cost Analysis; Critical care; Medical Emergency Team; Nurse Practitioner; Registrar.