Billing of Nursing Procedures at An Intensive Care Unit

This study aimed to: estimate the billing of nursing procedures at an intensive care unit and calculate how much of total ICU revenues are generated by nursing. An exploratorydescriptive, documentary research with a quantitative approach was carried out. The study was performed at a general ICU of a private hospital in the city of Sao Paulo. The sample consisted of 159 patients. It was concluded that the nursing procedures were responsible for 15.1% of total ICU revenues, which breaks down to an average 11.3% of revenues coming from nursing prescriptions and 3.8% from medical prescriptions. Demonstrating how much nursing contributes to hospital revenues is essential information for nursing managers, as it is an important argument to obtain resources and guarantee safe care.


Introduction
In 1993, the International Council of Nursing  Thus, nurse administrators are increasingly involved in financial decision and budget planning at their institutions and have to manage often scarce (human, material and financial) resources. Therefore, nurses need to seek knowledge in hospital administration and, today, also in accounting in order to manage their costs (3)(4)(5)(6)(7) .
The emphasis on cost containment and improved health system efficiency have created the explicit need to quantify and justify costs (3) . Nurses in hospitals, however, do not know data about nursing care costs and mainly billing (6,8) .
Billing is the "set of revenues expressed in monetary units, which a company obtains through the sale of goods or services in a given period". In other words, "it is the number of units of goods or services sold, multiplied by the unit sales price" (2) . This situation motivated the authors to investigate the extent to which nursing contributes to the revenues of an Intensive Care Unit (ICU) at a private hospital. The high cost of maintaining a structure as complex as an ICU has increasingly justified strict cost control in that area (9) . This unit has been responsible for the highest hospital spending, due to the demand for specialized staff, qualified in care delivery to critical patients, and to the continuous inclusion of new technologies; on the other hand, it has been one of the sectors with the highest billing.

Aims
To estimate the revenues nursing procedures generate per patient at an adult ICU of a general private hospital in São Paulo City, in May and June.
To estimate the percentage of total ICU billing that corresponds to nursing procedures during the months under analysis.   material price). The second served to collect notes from the medical prescription, with the same items.

Method
A pretest was performed on ten files and bills of patients who had already been discharged. The author completed the instruments with the data from the abovementioned files, analyzed and validated them together with professionals from the hospital's Audit and Accounts department.
For data analysis, descriptive analysis of the study variables was adopted, with distributions and frequencies, descriptive measures, means and standard deviation.
After completing the instruments with the data, these were transferred to Excel worksheets for storage.
To avoid disseminating amounts of ICU revenues, on the institution's request, the estimated contribution of nursing procedures was processed in reais and percentages. Billing of nursing prescription procedures is presented in Table 2, joining amounts for both months.

Descriptive
These statistics refer to one patient's summarized value.
Thus, one may say that, on average, R$ 85.56 are billed per patient for limb warming.  The results shown in Table 2  Next, Table 3 shows billing for medical prescription procedures, joining amounts for both months.     practice, as many other procedures are "embedded" in daily rates and room fees, such as: bathing, help with feeding, among others.
In hospital organizations, patient bills include daily rates, fees, material and drugs, distinguished per cost center, which is not the case for nursing procedures, which are displayed as a whole. This practice hampers rapid knowledge on nursing billing in each sector.
For the sake of this research, information had to be collected from nursing notes in order to distinguish ICU procedures.
Thus, it is suggested that all items charged on the patient bill be specified per Cost Center, which will facilitate monitoring by nurses at the study hospital and also future studies.

Conclusion
Through this research, the revenues nursing procedures generated at an ICU could be estimated, as well as their percentage in total billing.
Showing the extent to which nursing contributes to unit billing is one way to disclose these professionals' vital role in the results of a business unit and in the organization as a whole. Also, it serves as a management and negotiation tool for strategic planning of physical, human, material and financial resources at the hospital.
Thus, it is important for nurses to know how nursing care costs are appropriated and to show their importance not only in cost reduction, but also in revenue generation. Therefore, nurses should increasingly involve in these issues, seeking training needed to develop cost calculation methods through which the true cost of nursing care for hospital revenues can be measured.