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Minerva Anestesiologica 2000 July-August;66(7-8):541-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

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.