ต้นทุนฐานกิจกรรมการพยาบาลสำหรับผู้ป่วยฉุกเฉินและวิกฤตในหอผู้ป่วยหนักโรงพยาบาลแมคคอร์มิค จังหวัดเชียงใหม่

Abstract

The effective management of resources used in providing nursing services requires cost data based on nursing activities. This descriptive study aims to analyze the activity-based cost of nursing activities for emergency and critical patients in the Intensive Care Unit, McCormick Hospital, Chiang Mai Province and compare the activity-based cost of nursing activities with the medical expense reimbursement guidelines of the Ministry of Public Health and the National Institute ofEmergency Medicine, category 12. The conceptual framework used for Activity-Based Costing, introduced by Kaplan and Cooper (1998), is composed of four steps: 1) develop the activity dictionary, 2) determine how much the organization spending on each of its activities, 3) identifying the organization’s products, services, and customers, and 4) select activity cost drivers that link activity costs to the organization’s product, services, and customers. The subjects of the study include 10 nurses and 8 nursing assistants, and the nursing activities provided to emergency and critical patients admitted in the Intensive Care Unit, McCormick Hospital from August 1, 2019 to September 30, 2019. The instruments used in this study, developed by the investigator, consisted of the activity dictionary, time spend record form for activities, and the data record forms for labor costs, material costs, and capital costs. All instruments were confirmed for objectivity by three experts and the interrater reliability of the two data collectors was 1.0. Data were analyzed using descriptive statistics. Results revealed that: 1. The activity-based costing of nursing activities for emergency and critical patients in the Intensive Care Unit, McCormick Hospital, Chiang Mai Province with the top three highest costs were: 1) nursing care for patients on volume control respirator/day cost 2,065.45 THB and the ratio of labor costs:material costs:capital costs was 6.07:74.56:19.37; 2) large open wound dressing (wound dressing takes > 15 minutes, dressing scald wounds from second-degree burns) cost 824.91 THB and the ratio of labor costs:material costs:capital costs was 18.67:81.33:00.00; 3) nursing care for patients on volume control respirator < 8 hours cost 739.92 THB and the ratio of labor costs:material costs: capital costs was 13.95:70.28:15.77. 2. The cost of 11 nursing activities (52.38%) of emergency and critical patients in the Intensive Care Unit, McCormick Hospital was higher than the medical expense reimbursement guidelines set by the Ministry of Public Health and the National Institute of Emergency Medicine, category 12. Hospital and nursing administrators can use the results of this study as a database to manage resources effectively in nursing activities for emergency and critical patients in the Intensive Care Unit, McCormick Hospital, Chiang Mai Province.