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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES CRITICAL AND INTENSIVE THERAPY
Minerva Anestesiologica 2000 July-August;66(7-8):541-7
Measuring complexity/level of care and appropriateness of resource use in Intensive Care Units
Iapichino G., Pezzi A., Minelli C., Radrizzani D., Barberis B., Belloni G., Bianchi P.
Background. Throughout the world, the cost of critical care medicine is increasing more than the overall health care cost. Thus, a higher attention to improve the efficiency of the use of ICU resources is indispensable. The objective of this study was the development of a simple and reliable tool for the evaluation of the appropriateness of ICU utilization.
Methods. Design: A repeated cross-sectional data collection was performed twice a week, during a 61-day study period. Setting: Twenty-three Italian general ICUs. Patients: All patients present in the 23 ICUs on the 17 index days. Interventions: On each index day, patients were checked for receiving ventilation/CPAP, pulmonary arterial pressure monitoring, intracranial pressure monitoring, vaso-active drug infusion and hemodialysis-ultrafiltration. Simultaneously, each ICU bed was assessed for its technical and personnel facilities in order to estimate the deliverable level of care.
Results. A total of 1250 patients were studied, for a total number of 7533 patient-days. The overall occupancy rate per ICU was 83.8% (range: 54.4% to 96.1%). The high-level occupancy rate (rate of patients requiring high level of care and actually occupying high-facility beds) was 69.4% (range: 25.0% to 149.0%), while the corresponding low-level occupancy rate was 101.1% (range: 31.3% to 329.4%).
Conclusions. Our model clearly showed up a certain degree of inappropriateness in the use of ICU resources. Most of the ICUs (69.6%) used a very large proportion of their high-facility beds for patients who did not need high-level care. Being very simple, our method could represent a useful tool for continuous evaluation of the appropriateness of resource utilization in the ICU.