PP512 Topic: AS23–Rehabilitation: Early Mobilization/Interdisciplinary Care/Developmental Care/Other: COST ANALYSIS OF IMPLEMENTING AN EARLY REHABILITATION BUNDLE IN A PEDIATRIC INTENSIVE CARE UNIT
Bibliographic record
Abstract
Background: We implemented an early rehabilitation bundle (PICU Liber8) focused on sedation stewardship, delirium monitoring, and early mobilization at McMaster Children’s Hospital Pediatric Intensive Care Unit (PICU) Aim: To determine the cost and resources required to implement Liber8 and compare patient-level costs pre- and post-implementation. Methods: Implementation consisted of 4 phases: Engage, Educate, Execute, and Evaluate. For human resources, we calculated hours spent by personnel and their hourly wage. Patient-level costs were calculated using Ontario Case Costing Initiative for all patients who completed a PICU stay between January-March 2019 (pre) and January-March 2020 (post-implementation period). Linear regression was used to compare total patient-level PICU and pharmacy costs respectively in the pre- and post implementation periods, adjusted for age, sex and PIM3 score. Results: A total of 949 hours were spent on developing and implementing Liber8. Majority of human resource hours (58%) were spent during Engagement. Total personnel hours cost $50,090, majority of which were contributed by physicians (attendings and fellows) ($28,497), followed by nurses ($6899) and pharmacists ($4500). We evaluated 484 pre-implementation and 316 post-implementation patient days respectively. Non-adjusted total patient costs pre-implementation was $2.5million vs. $1.5million post-implementation (adjusted mean difference 17.1% [95% CI -6.3,46.4]). Mean cost per patient day was $588 lower post-implementation ($5,052) vs. pre-implementation ($4664) Conclusions: The majority of resources required for implementing a rehabilitation are spent on engagement and planning activities. Due to larger variations in costs, statistical nonsignificance is not surpirsing. However, it is important to highlight the magnitude of the difference, not statistical significance. Keywords: Early Rehabilitation, Implementation, pediatric intensive care unit, Cost Analysis
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.015 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".