Top-down costing: Problems in determining staff costs in intensive care medicine

Objective: To describe the activities carried out by the staff of Italian ICUs and to quantify the amount of working time devoted to ICU patients. Design and setting: Prospective, observational, multicenter study in 110 ICUs to report the non-ICU-related activities performed by ICU staff, together with the time such activities require. Of the 110 ICUs 80 participated in the project. Measurements and results: We found substantial variation in the number of activities carried out and in the working time allocated to such activities. Considering the differences in the number of employees, their salaries, and the amount of time spent performing various activities, it was found that the personnel cost for ICU activity was 83.4% (range 55-100%) of the total personnel costs. Conclusions: Given the wide variation in the number of activities performed and in the proportion of working time spent performing non-ICU related activities, data comparing costs between different ICUs should be interpreted with caution.