Outline the factors you would consider in making a cost-benefit analysis of introducing a new component of care into your Intensive Care unit.
Any component of care could be assessed (eg. staffing levels, equipment, new techniques or drugs).
• Strength of evidence supporting the new component of care (eg. more than one adequately powered prospective randomised clinical trial). Internal validity of trials (adequacy of methodology).
• External validity of trials or other supporting information (ie. ability to extrapolate to the patients that you are managing).
• Ability to accurately identify those patients who would benefit from new component of care.
Accurate identification of patients prospectively decreases costs by decreasing the number of patients who will need to be treated but who will not benefit (or may even be harmed).
• Magnitude of outcome benefit found (eg. number needed to treat to achieve specific outcome). Consider survival to hospital versus 30 day survival versus 12 month survival.
• Additional costs that may be generated by achieving that outcome (eg. costs of hospitalisation or other care, incurred after survival). Comparison with costs generated (or saved) by alternative strategy.
• Source of funding for costs should be considered. Special grant (above and beyond current budget) or would any additional costs be paid from existing budget (requiring cost cutting in other areas).
Of the vague questions from the early papers of the CICM fellowship, this one is a peach. The poor candidate would have to guess what was meant by "new component of care". Do they mean the puchase of new equipment? The implementation of a new hand-washing protocol? The hiring of new cleaners? A modification of the departmental toast-buttering policy? These things are unclear.
Let us consider the question in generic terms.
Evidence in support of the new component
Cost-benefit analysis of new component
Logistics of implementation
Valentin, Andreas, and Patrick Ferdinande. "Recommendations on basic requirements for intensive care units: structural and organizational aspects."Intensive care medicine 37.10 (2011): 1575-1587.
Laupacis, A., et al. "How attractive does a new technology have to be to warrant adoption and utilization? tentative guidelines for using clinical and economic evaluations." CMAJ: Canadian Medical Association Journal 146.4 (1992): 473.