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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
TOWARDS AN ETHICAL MANAGEMENT OF INTENSIVE CARE SMART 2002 Milan, May 29-31, 2002
Minerva Anestesiologica 2002 April;68(4):201-7
Assessment of adequacy of ICU admission
Irone M., Parise N., Bolgan I., Campostrini S., Dan M., Piccinni P.
From the Anesthesia and Intensive Care Department O.C. San Bortolo, Vicenza (Italy) and *Department of Statistical Science University of Padua (Italy)
Background. Direct costs of critical care are increasing more than in other health care sectors. Tools are needed to evaluate adequacy of ICU admission in order to have a proper allocation of ICU resources. Objective: evaluation of different ways used to assess adequacy of ICU admission.
Methods. Study type: 12 months prospective descriptive study. Setting: 24 Intensive Care beds of a 1000 beds tertiary hospital in Italy. Patients: 2314 patients admitted to Cardiac Surgery, General and Postoperative Intensive Care Units. Interventions: all patients admitted to the ICUs were studied. Information was collected for the patients’ age, source of admission, diagnoses, surgical status, reason for admission, SAPS II score, NEMS daily score, LOS, ICU outcome. The number of available beds (ventilated or not) and nurse working hours were obtained.
Results. 2373 patients were admitted to the ICs, with an overall readmission rate of 2.5%, and a total amount of 8084 NEMS record. The mean Work Utilization Ratio was significantly different between the three IC and between working and weekend days in PACU and CSU. The 49.7% of the NEMS points is scored by the SAPS II 43-78 patients, corresponding to the 29.2% of >24 h admissions. The level of care provided and the trend of each admission was derived from NEMS score according to Iapichino. The proportion of HT records in each IC was 88.3% in ICU, 73.1% in PACU and 91.2% in CSU; the outcome (dead/discharged) was significantly different between LT and HT.
Conclusions. Despite the difficulties imposed by he rigid nurses’ work organization in Italy, a daily data collection about level of care, severity of illness, workload utilization could provide, together with standard administrative indexes, the necessary framework to assess and to improve adequacy of ICU admission.