重症监护室护士对交接班效果的评价

目的了解重症监护室(ICU)护士对交接班效果的评价,并分析其影响因素,旨在采取管理措施提高ICU护士交接班质量,减少患者安全隐患。方法采用护士交接班评估量表对203名ICU护士进行调查,调查内容包括有效与高效交班,保证患者安全,促进患者参加,增进护士监督、合作、责任,提供患者信息。结果护士对交接班效果的总体评分为(4.23±0.58)分,各维度评分分别为:有效与高效交班(4.41±0.63)分,保证患者安全(4.41±0.59)分,促进患者参加(4.20±0.63)分,增进护士监督、合作、责任(4.23±0.61)分,提供患者信息(3.90±0.84)分;ICU类型、工龄及职称是护士对交接班效果评价的影响因素(P0.05,P0.01)。结论ICU护士认同交接班是有效及高效的,能保证患者安全,但患者参与度低。ICU护士交接班需要进一步地促进患者参与度,增加合理的监督,减少压力源,以期提高交接班质量。     

Stressors in the intensive care unit: comparing the perceptions of Chinese patients and their family

Admission into an intensive care unit (ICU) is deemed a stressful event by both patients and their families. It has been reported that relatives often have a different perception of the patients' stress levels in comparison with the patients themselves. This study aims to identify stressors in the ICU as perceived by the Chinese patients and their relatives. A convenience sample of 60 patients and 60 relatives was selected for this study. The Intensive Care Unit Stressor Questionnaire [Chinese] was tapped to collect the patients' perceptions of stressors. Their respective relatives were likewise asked to rate the stressors according to how they perceive the patients would rate them. A comparison between the two sets of questionnaires would reveal that the relatives evaluated the items to be more stressful than the actual perception of patients. The overall perceived stress level of ICU patients was significantly lower than their respective relatives' (z = ?6.51, p < 0.001), with a mean difference of 44.71 (mean: 61.57 versus 106.28) between the two groups. It is therefore essential that appropriate strategies be implemented to alleviate the stressful feelings perceived by the patients and their families. The influence of cultural beliefs on the perceived stress level of the general Chinese population was likewise highlighted. Copyright © 2008 John Wiley & Sons, Ltd.     

Risk Factors for Unplanned Admission to the Intensive Care Unit After Elective Total Joint Arthroplasty

BackgroundDespite improved surgical and anesthesia techniques, as well as advances in perioperative protocols, a number of patients undergoing total joint arthroplasty (TJA) are at risk of serious medical complications that require intensive care unit (ICU) admission. With the recent move toward performing TJA in ambulatory surgical centers and on an outpatient basis, it is important to recognize patients that may require intensive care in the postoperative period. This study aimed to identify risk factors for ICU admission following elective total hip (THA) and knee (TKA) arthroplasty.MethodsWe evaluated 12,342 THA procedures, with 132 ICU admissions, and 10,976 TKA procedures, with 114 ICU admissions from 2005 to 2017. Demographic, preoperative, and surgical variables were collected and compared between cohorts using both univariate and logistic regression analysis.ResultsFor THA, logistic regression analysis demonstrated older age, bilateral procedure, revision surgery, increased Charlson comorbidity index, general anesthesia, increased estimated blood loss, decreased preoperative hemoglobin, and increased preoperative glucose level were independently associated factors for increased risk of ICU admission. For TKA, increased age, increased body mass index, bilateral procedure, revision surgery, increased Charlson comorbidity index, increased estimated blood loss, general anesthesia, and increased preoperative glucose were independently significantly associated with ICU admission.ConclusionIn this study, we identify a number of critical independent risk factors which may place patients at increased risk of ICU admission following THA and TKA. Identification of these risk factors may help surgeons safely select those TJA candidates appropriate for surgery at facilities that do not have ICUs readily available.     

Outcome from intensive care after cardiac arrest: comparison between two patient samples treated in 1986-87 and 1999-2001 in Finnish ICUs

BACKGROUND: The aim of the study was to find out whether the characteristics of patients and the outcome from intensive care after cardiac arrest have changed over time. METHODS: Two nationwide databases were compared: (i) The Finnish National Intensive Care Study data in 1986-87 and (ii) data on 28,640 admissions to Finnish ICUs in 1999-2001. Patients whose reason for ICU admission was cardiac arrest were included. The former study included 604 patients treated in 18 medical and surgical ICUs in and the latter 1036 patients in 25 medical and surgical ICUs. Data on the components of Acute Physiology and Chronic Health Evaluation (APACHE II) were prospectively collected in both study periods. Logistic regression analysis was used to test the independent contribution of the study period on hospital mortality. RESULTS: In 1986-87, patients were younger and the proportion of males was lower than in 1999-2001. The hospital mortality in 1986-87 was 61.3% and in 1999-2001 59.1% (P= 0.396). Among patients aged < 57 years, the hospital mortality in 1986-87 was 62.1% and in 1999-2001 48.8% (P < 0.01). In multivariate analysis, controlling for age, gender, Glasgow coma score (GCS), chronic health evaluation points and source of admission, treatment during 1986-87 was an independent predictor for hospital death among all patients (OR 1.273; 95% CI 1.015-1.594), those aged < 57 years (OR 1.959; 95% CI 1.270-3.021) and among males (OR 1.384; 95% CI 1.050-1.825). CONCLUSION: Since the late 1980s, the outcome from intensive care after cardiac arrest may have improved especially among younger patients and males.     

Interdisciplinary communication in the intensive care unit

BACKGROUND: Patient safety research has shown poor communication among intensivecare unit (ICU) nurses and doctors to be a common causal factorunderlying critical incidents in intensive care. This studyexamines whether ICU doctors and nurses have a shared perceptionof interdisciplinary communication in the UK ICU. METHODS: Cross-sectional survey of ICU nurses and doctors in four UKhospitals using a previously established measure of ICU interdisciplinarycollaboration. RESULTS: A sample of 48 doctors and 136 nurses (47% response rate) fromfour ICUs responded to the survey. Nurses and doctors were foundto have differing perceptions of interdisciplinary communication,with nurses reporting lower levels of communication opennessbetween nurses and doctors. Compared with senior doctors, traineedoctors also reported lower levels of communication opennessbetween doctors. A regression path analysis revealed that communicationopenness among ICU team members predicted the degree to whichindividuals reported understanding their patient care goals(^adjR² = 0.17). It also showed that perceptions of the qualityof unit leadership predicted open communication. CONCLUSIONS: Members of ICU teams have divergent perceptions of their communicationwith one another. Communication openness among team membersis also associated with the degree to which they understandpatient care goals. It is necessary to create an atmospherewhere team members feel they can communicate openly withoutfear of reprisal or embarrassment.     

Physicians' perceptions and attitudes regarding inappropriate admissions and resource allocation in the intensive care setting

Background. Physicians' perceptions regarding intensive careunit (ICU) resource allocation and the problem of inappropriateadmissions are unknown. Methods. We carried out an anonymous, self-administered questionnairesurvey to assess the perceptions and attitudes of ICU physiciansat all 20 ICUs in Milan, Italy, regarding inappropriate admissionsand resource allocation. Results. Eighty-seven percent (225/259) of physicians responded.Inappropriate admissions were acknowledged by 86% of respondents.The reasons given were clinical doubt (33%); limited decisiontime (32%); assessment error (25%); pressure from superiors(13%), referring clinician (11%) or family (5%); threat of legalaction (5%); and an economically advantageous ‘DiagnosisRelated Group’ (1%). Respondents reported being pressurizedto make more ‘productive’ use of ICU beds by Unitheads (frequently 16%), hospital management (frequently 10%)and colleagues (frequently 4%). Five percent reported refusingappropriate admissions following ‘indications’ notto admit financially disadvantageous cases. Admissions afterelective surgery prioritized patients from profitable surgicaldepartments: frequently for 6% of respondents and occasionallyfor 15%. Sixty-seven percent said they frequently received requestsfor appropriate admissions when no beds were available. Thiswas considered sufficient reason to withdraw treatment frompatients with lower survival probability (sometimes 21%) orfor whom nothing more could be done (sometimes 51%, frequently11%). Conclusions. Inappropriate ICU admissions were perceived asa common event but were mainly attributed to difficulties inassessing suitability. Physicians were aware that their decisionswere often influenced by factors other than medical necessity.Economic influences were perceived as limited but not negligible.Decisions to forgo treatment could be influenced by the needto admit other patients. Presented, in part, at the Joint Meeting of the European Societyof Anaesthesiologists and European Academy of Anaesthesiology,Lisbon, Portugal, June 5–8, 2004, and published in abstractform in Eur J Anaesthesiol 2004; 21 (Suppl 32): A712.     

Readmission to the intensive care unit: An indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit

Purpose  To investigate the characteristics and outcomes of surgical patients who were readmitted to the intensive care unit (ICU). Methods  The data were collected for all readmissions to the surgical ICUs in a tertiary hospital in the year 2003. Results  Of all the 945 ICU discharges, 110 patients (11.6%) were readmitted. They had a longer initial ICU stay (8.05 ± 7.17 vs 5.22 ± 4.95, P < 0.001) and were older and in a more severe condition than those not readmitted, but with a longer hospital stay and higher mortality rate (40% vs 3.6%, P < 0.001). A total of 26.4% of the readmission patients had an early readmission (<48 h), with a lower mortality rate than those with a late readmission (24.1% vs 45.7%, P = 0.049). A total of 46.4% of the patients were readmitted with the same diagnosis while the rest were readmitted with a new complication. Respiratory disease was the most common diagnosis for patients readmitted with a new complication (66.1%). The nonsurvivors had a significantly higher second Acute Physiology and Chronic Health Evaluation (APACHE II) score (22.1 ± 8.8 vs.14.6 ± 7.4, P < 0.001) and second Therapeutic Intervention Scoring System (TISS) score (30.1 ± 8.7 vs 24.7 ± 7.6, P = 0.001) and a longer stay in the first ICU admission (10.4 ± 9 days vs 6.4 ± 5 days, P = 0.010). A multivariate analysis showed that the first ICU length of stay and the APACHE II score at the time of readmission were the two risk factors for mortality. Conclusion  The mortality of surgical patients with ICU readmission was high with respiratory complications being the most important issue.     

The proportion of intensive care unit admissions related to alcohol use: a prospective cohort study

BACKGROUND: Alcohol abuse is a risk factor for serious illnesses, and a history of chronic alcohol abuse adversely affects the outcome of critically ill patients. It is not known what proportion of intensive care unit (ICU) admissions is related to alcohol use. Therefore, we investigated the proportion of emergency admissions related to alcohol. METHODS: A prospective cohort study was conducted in a university hospital ICU. All adult patients (n = 893) who underwent emergency admission to our ICU during a period of 1 year were studied. RESULTS: The admitting physician determined whether there was a relationship between alcohol use and admission. ICU and hospital mortality and ICU length of stay (LOS) were recorded. The Therapeutic Intervention Scoring System (TISS) was used for ICU resource use estimation. There was a relationship between alcohol use and admission in 24% (215/893) of admissions and, in 156/893 admissions (17.5%), this seemed to be definite. ICU LOS was 1.2 days (0.7; 2.3) (median; interquartile range) for alcohol-related and 1.8 days (0.9; 3.6) for other admissions (P < 0.001). Patients with alcohol-related admissions consumed 17.8% of ICU patient-days and 18.7% of all accumulated TISS scores. ICU (8.8 vs. 10.5%, P = 0.603) and hospital (19.1 vs. 20.2%, P = 0.769) mortalities were no different between alcohol-related and other admissions. CONCLUSION: ICU admission is very often related to long-term chronic and/or occasional alcohol use.     

ICU医护合作与护士职业获益感的相关性研究

目的调查ICU医护合作关系及ICU护士职业获益感,分析医护合作对护士职业获益感的影响。方法采用医护合作量表、护士职业获益感量表对230名ICU护士进行调查。结果医护合作量表总分为(90.60±14.48)分,条目均分为(3.62±0.58)分;护士职业获益感总分为(133.39±17.11)分,条目均分为(4.04±0.52)分。回归分析显示,护士和医生的关系、患者信息的交流能力及职称是护士职业获益感的主要影响因素(调整R2=0.428)。结论ICU医护合作和护士职业获益感较高,且医护合作是护士职业获益感的重要影响因素,管理者应重视医护合作关系的建设,提升护士的积极职业认知。     

Withholding and withdrawal of therapy in New Zealand intensive care units (ICUs): a survey of clinical directors

Withdrawing and withholding life-support therapy in patients who are unlikely to survive despite treatment are common practices in intensive care units (ICUs). The literature suggests there is a large variation in practice between different ICUs in different parts of the world. We conducted a postal survey among all public ICUs in New Zealand to investigate the pattern of practice in withholding and withdrawal of therapy. Nineteen ICUs responded to this survey and they represented 74% of all the public ICU beds and 83% of the annual ICU admissions. The percentage of ICU admissions with therapy withdrawn or withheld was less than 10% in most ICUs. Only a small percentage (21%) of ICUs had a formal policy in withholding and withdrawal of therapy. The timing of making the decision to withhold or withdraw therapy was very variable. The patient and/or the family, the primary medical team consultant, two or more ICU consultants, and ICU nurses were usually involved in the decision making process. ICU nurses were more commonly involved in the decision making process in smaller ICUs (5 beds vs 10 beds, P = 0.03). The patient's pre-ICU quality of life, medical comorbidities, predicted mortality, predicted post-ICU quality of life, and the family's wishes were important factors in deciding whether ICU therapy would be withheld or withdrawn. Hospice ward or the patient's home was the preferred place for palliative care in 32% of the responses.     

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia‐related entries in patients’ records over a 24‐h period, in 45 adult intensive care units (ICUs) in London and the South‐East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two‐thirds of patients (n = 475, 64.5%, 95%CI 60.9–67.8%) received no physician‐documented pain assessment during the 24‐h study period. Just under one‐third (n = 215, 28.6%, 95%CI 25.5–32.0%) received no nursing‐documented pain assessment, and over one‐fifth (n = 159, 21.2%, 95%CI 19.2–23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician‐documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed.     

The effect of tracheostomy on outcome in intensive care unit patients

BACKGROUND: Percutaneous dilatation tracheostomy (PDT) is increasingly being used in the intensive care unit (ICU), and has probably increased the number of procedures performed. The primary aim of this study was to document the short- and long-term outcome of patients with a tracheostomy performed during an ICU stay. METHODS: Patients in our ICU who underwent an unplanned tracheostomy between 1997 and 2003 were included in this analysis. The type of tracheostomy (PDT or surgical tracheostomy) and time of the procedure were registered prospectively in our ICU database. Survival was followed using the People's Registry of Norway and morbidity data from the individual hospital record. These patients were also compared with a group of ICU patients ventilated for more than 24 h, but managed without a tracheostomy. We also compared patients who had early tracheostomy (less than median time to procedure) with those who had late tracheostomy. RESULTS: Of the 2844 admissions (2581 patients), unplanned tracheostomy was performed during 461 admissions (16.2%) on 454 patients (17.6%). The median time to tracheostomy was 6 days. The ICU, hospital and 1-year mortality rates were 10.8, 27.1 and 37.2%, respectively, significantly less than those of the group ventilated without tracheostomy. The median time to decannulation was 14 days. Patients who had early tracheostomy had a more favourable long-term survival than those who had late tracheostomy. No procedure-related mortality was registered. CONCLUSIONS: In our ICU, having a tracheostomy performed was associated with a favourable long-term outcome with regard to survival, and early tracheostomy improved survival in addition to consuming less ICU resources.     

Trends in the use of renal replacement therapy modality in intensive care unit: a 7 year study

Abstract

Background: The use of renal replacement therapy (RRT) modality in the intensive care unit (ICU) depends primarily on provider preference and hospital resource. This study aims to describe the prevalence of RRT use and the trends in RRT modality use in the ICU over the past 7 years. Methods: All ICU admissions, including medical, cardiac, and surgical ICUs from 1 January 2007 to 31 December 2013, were included in this study. RRT use was defined as the use of intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) within a given ICU day. The RRT use was reported as the proportion of ICU days on each RRT modality divided by the total ICU days with RRT usage. Results: Over the course of this study (72,005 ICU admissions), 272,271 ICU days were generated. RRTs were used in 4110 ICU admissions (5.7%) and on 21,159 ICU days (7.8%). RRT use was 10,402 (49%) for IHD, and 10,954 (52%) for CRRT. The trend of IHD and CRRT use did not change from year 2007 to 2013. On ICU days with RRT, the choice of RRT modality was associated with the number of vasopressor use (p?<?0.001). CRRT was more preferred on the ICU days with the increasing number of vasopressor use. Conclusions: RRTs were used in about 6% of ICU admission. The use of IHD and CRRT was similar and did not change over 7 years. The choice of RRT modality mainly depended on the number of vasopressors used on ICU days with RRT.     

The use and safety of transoesophageal echocardiography in the general ICU -- a minireview

BACKGROUND: The efficacy of transoesophageal echocardiography (TEE) has been evaluated predominantly in medical and cardiac surgical ICUs. This article reviews the pertinent literature and evaluates the impact of TEE in a general surgical ICU. METHODS: Twenty studies on TEE in the ICU were evaluated for complications, indications, diagnostic, therapeutic, and surgical impact on patient management. Diagnostic impact was defined as identification of the underlying cardiovascular pathology, therapeutic impact as changes in patient management and surgical impact as indication for operative procedures. In addition, we reviewed the TEE reports and patient charts of 216 critically ill patients in a 16-bed multidisciplinary surgical ICU at our university hospital, who underwent a TEE for differential diagnosis of hemodynamic instability from July 1995 to December 1998 to assess the impact of TEE on patient management in a general surgical ICU. RESULTS: The diagnostic, therapeutic and surgical impact in a total of 2,508 patients ranged from 44 to 99% (weighted mean 67.2%), 10-69% (36.0%), and 2-29% (14.1%), respectively. The complication rate was 2.6%, with no examination related mortality. In our series in a general surgical ICU, a diagnostic, therapeutic and surgical impact was inferred in 191 (88.4%), 148 (68.5%) and 12 (5.6%) patients, respectively. Adverse effects were observed in 5.6%. CONCLUSION: TEE is safe, well-tolerated and useful in the management of critically ill patients. This applies as well for hemodynamically unstable patients in a general surgical ICU.     

INTENSIVE CARE UNIT ADMISSIONS FOLLOWING LAPAROSCOPIC SURGERY: WHAT LESSONS CAN BE LEARNED?

Background: Laparoscopic surgery has been widely embraced, often without adequate data concerning the range and incidence of complications. In the present series, our experience of complications requiring Intensive Care Unit (ICU) admission following laparoscopic surgery is described. Methods: The records of patients requiring ICU admission at John Hunter Hospital (JHH) following laparoscopic surgery over a 39 month period were retrospectively reviewed by an independent multidisciplinary panel. Results: Twenty-three ICU admissions were identified. Twenty-one followed general surgical laparoscopic procedures and two followed gynaecological laparoscopies. Ten cases were operated on initially at JHH and 13 were transferred from other hospitals. During the study period, 2444 laparoscopic surgical cases were performed at JHH; 725 general surgical procedures (1.37% admitted to ICU) and 1719 gynaecological procedures (no ICU admissions). Twelve cases suffered surgical complications (including five gastrointestinal tract perforations and three biliary tract injuries) and 11 cases were admitted for non-surgical problems. In 75% of surgical complications there was delay in diagnosis of more than 24 h. The duration of ICU stay for surgical complications (16.4 days) was significantly longer than for the non-surgical group (3.9 days). Conclusions: There was a greater likelihood of ICU admission following general surgical rather than gynaecological laparo-scopy. Fifty-two per cent of the admissions were for surgical complications. Surgical complications are characterized by delay in diagnosis and longer ICU admission periods. Strategies to prevent some of these complications are discussed.     

End-of-life-care in the intensive care unit

The past 4 years has seen an expansion of end-of-life-care (EoLC) in the intensive care unit (ICU), especially in Western countries. ICUs are increasingly becoming the preferred place for the complex dying patient whether intentionally or not. For the majority of patients who die on ICU, it is a planned event with the numbers requiring cardiopulmonary resuscitation reducing. With general ICU mortality being between 20 and 30 %, ‘dying’ is one of the most common ICU diagnoses, making EoLC a daily responsibility for the ICU doctor at all levels of training. Acquiring the knowledge, practical skills, compassion and communication to manage the needs of the diverse population admitted to ICU takes time, but when it is done well this can be a rewarding area of practice. Once it is recognized that a patient is dying, a structured approach and shift in emphasis of patient care has been shown to improve family satisfaction and reduce complaints. This article talks through four real-life cases to bring attention to clinical skills, a structured approach for communication and a decision-making process with reference to the relevant paragraphs of the General Medical Council (GMC) guidelines: Treatment and Care Towards the End-of-Life.     

Patient satisfaction with care in the intensive care unit: can we rely on proxies?

Background: To investigate whether next of kin can be addressed as proxy to assess patients' satisfaction with care in the intensive care unit (ICU). Methods: Prospective observational multicentre study. Two hundred and thirty‐five patients with an ICU length of stay of ≥2 days and 266 of their adult next of kin participated. Patient satisfaction was assessed by a questionnaire, distributed upon discharge from an ICU and compared with next of kin's answers. The possible range of answers was 0–100, with higher numbers indicating higher satisfaction. The main outcome measure was the extent of agreement between patients' satisfaction with care and the ratings of their next of kin. Results: Patients were most satisfied concerning physicians' competence (86.7±16.3), while least satisfaction was observed for the management of agitation and restlessness (78.2±23.5). There was no significant difference between next of kin's and patients' ratings. Agreement between patients and proxies was the highest concerning overall satisfaction (Cohen's κ 0.40) and the lowest for coordination of care (0.24). Spouses/partners had a higher agreement with the patients' ratings than other proxies. Conclusions: If the patient is unable to rate his satisfaction with care in the ICU, next of kin may be taken as an appropriate surrogate. Trial registration: The study has been registered at ClinicalTrials.gov, Reg No: NTC 00890513.     

Knowledge,attitude, and practice of nurses in intensive care unit on preventing medical device–related pressure injury: A cross‐sectional study in western China

The knowledge, attitude, and practice of nurses in intensive care units (ICUs) are determinants for the efficacy of preventing the medical device–related pressure injury (MDRPI). The aim of this study was to determine the level and factors of knowledge, attitude, and practice of nurses'' ICUs on preventing medical MDRPI in western China. An annual cross‐sectional study was conducted in hospitals of western China from May 2020 to September 2020. Nurses'' knowledge and attitudes were assessed using Clinical Nurses Prevention MDRPI of Critically Ill Patients for the Knowledge, Attitude, Practice Assessment Scale. SPSS software version 25.0 and independent t‐test, Chi‐square, Fisher exact, one‐way analysis of variance, and multiple linear regression tests were used for data analysis. A total of 1002 nurses in ICUs from 37 hospitals in Gansu Province, China, participated in this study. The scores of overall KAP, knowledge, attitudes, and practice were 149.17 ± 24.62, 53.83 ± 12.23, 37.24 ± 6.35 and 58.10 ± 9.83, respectively. There was a positive and significant relationship between three variables. Findings revealed that nurses'' knowledge score in the Tertiary hospital was higher than scores of other hospitals as 3.840 units. Moreover, the knowledge score and practice score of nurses with bachelor''s degree or above were higher than other nurses and are 0.978 and 1.106 units, respectively. Based on the findings, practice of nurses increased by 0.992 units, with a 1‐year increase in work experience of nurses in the ICU. The levels of knowledge, attitude, and practice of nurse in ICUs on preventing MDRPI were acceptable. The findings of the study highlight that a comprehensive approach should be conducted for raising the level of knowledge, attitude, and practice of nurses'' ICUs on preventing medical MDRPI, as well as improving the quality of care for critically ill patients.     

Results and costs of intensive care in a tertiary university hospital from 1996-2000

BACKGROUND: Costs of intensive care may be 20% of all hospital costs. Population aging likely increases the demand for intensive care services, while health care has financial limitations. Therefore data about outcome and costs of intensive care are needed. We studied changes in patient characteristics, outcome, intensity of care and costs of intensive care in a tertiary university hospital in Finland. METHODS: We analyzed retrospectively data of patients admitted to the ICU between 1 January 1996 and 31 December 2000 using the patient data management system. Postoperative and ICU patients were analyzed separately. Data included age, Apache II score, cause of intensive care admission, length and intensity of ICU care. ICU, hospital and 6-month mortality were analyzed. Intensity of care was assessed by TISS points and the annual costs of intensive care were evaluated. RESULTS: The number of ICU admissions from 1996-2000 was 11,323. The proportions of ICU and postoperative patients were 39% and 61%, respectively. The mean age of the patients did not change. The mean Apache II score increased over time both in the ICU and postoperative patients. There was no change in crude hospital mortality. Total ICU costs decreased from 8,660,000 euros (in 1997) to 7,480,000 euros (in 2000). In the ICU patients, the costs of hospital survival decreased towards the end of the study period. CONCLUSIONS: We treated more severely ill patients with unchanged outcome but at lower costs towards the end of the study period. Costs of intensive care are not necessarily increasing.