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CURRENT ISSUEMINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2002 April;68(4):201-7

SMART 2002 Milan, May 29-31, 2002 

 TOWARDS AN ETHICAL MANAGEMENT OF INTENSIVE CARE

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.

language: English


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