DESCRIPTIVE ANALYSIS OF CRITICAL CARE UNITS IN THE UNITED-STATES - PATIENT CHARACTERISTICS AND INTENSIVE-CARE UNIT UTILIZATION
DESCRIPTIVE ANALYSIS OF CRITICAL CARE UNITS IN THE UNITED-STATES - PATIENT CHARACTERISTICS AND INTENSIVE-CARE UNIT UTILIZATION
复制标题
DOI：
10.1097/00003246-199302000-00022
复制
发表时间：
1993-02-01
影响因子：
8.8
通讯作者：
KAYE, W
中科院分区：
文献类型：
--
作者：
GROEGER, JS;GUNTUPALLI, KK;KAYE, W
目标。收集有关美国icu占用率、入院特征、患者年龄和治疗类型的数据。设计和设置。向4 233家医院的行政人员邮寄了调查文书，以便从各医院各自icu的医务主任那里收集信息，以便建立一个关于美国icu的数据库。本研究的抽样框架是基于所有美国医院协会（AHA）医院声明他们有icu。测量方法：人口普查问卷收集了关于入住情况、患者来自何处、住院时间、提供的治疗、重症监护诊断、复苏状态以及其他信息的信息。主要结果：获得了美国1706家医院2876个独立ICU的32850张ICU床位、25871名患者的数据。人口普查回复率为40%的美国心脏协会医院表示他们有ICU，具体的ICU数据为38.7%的全国ICU。总体而言，回应单位报告的平均入住率为总床位容量的84%和可用床位的87%。随着医院规模的扩大，重症监护病房的占用率也在增加。近17%的重症监护患者在病房里呆了100 - 14天。更准确地说，49%的应答单位表示他们有一个或多个“慢性”（住院时间为14天）患者。大多数患者来自急诊室（38%）、手术室/麻醉后护理病房（22%）和综合医院楼层（16%）。新生儿病房是这一观察的例外，其中大多数患者来自产房（60%）。来自其他医院的入院患者在心脏护理、儿科和新生儿病房中占比明显更大。答复者表示，他们目前的许多患者是老年人，其中43%的患者年龄在65至84岁之间，4%的患者年龄大于或等于85岁。当从分析中排除新生儿和儿科单位时，大于或等于65岁的患者的47%增加到58%。在所有接受调查的单位中，主要的重症监护诊断是术后管理、缺血性心脏疾病、呼吸功能不全/衰竭和早产。从分析中排除了主要治疗儿童（儿科和新生儿）的单位，留下了“成人”单位的三个主要入院诊断：缺血性心脏病、术后管理和呼吸功能不全/衰竭，根据具体单位类型而有所不同。儿科的主要诊断是呼吸功能不全/衰竭、术后处理和先天性异常。对于新生儿单位，早产是主要的入院诊断，占这些单位患者的59%。受访者报告称，5.3 +/- 10.9%的患者在入住重症监护病房前接受过心肺复苏（CPR）。在这些重症监护病房中，只有6.0 +/- 11.9%的患者得到了在病房内不进行心肺复苏术的指示。结论：本报告应被视为努力改善危重医学可用信息库和icu绩效的第一步。我们的调查结果提供了一个介绍到日常工作的重症监护单位在整个美国。在一个财政资源有限、人口老龄化、社会和伦理问题纷繁复杂的世界里，需要进行研究，以确定哪些患者将从重症监护中受益，以及如何有效地利用我们为他们提供的庞大技术。
Objective. To gather data about occupancy, admission characteristics, patients' ages, and types of therapy utilized in ICUs in the United States.Design and Setting. Survey instruments were mailed to the administrators of 4,233 hospitals to gather information from the medical director of the institutions respective ICUs for the purpose of developing a database on ICUs in the United States. The sampling frame for this study was based on all American Hospital Association (AHA) hospitals stating they had ICUs.Measurements: Census questionnaires solicited information on occupancy, where the patients were admitted from, length of stay, therapies rendered, intensive care diagnoses, and resuscitation status, as well as other information.Main Results: Data were obtained regarding 32,850 ICU beds, with 25,871 patients from 2,876 separate ICUs in 1,706 hospitals in the United States. The census response rate was 40% of the AHA hospitals that stated they had ICUs, with specific ICU data on 38.7% of the nation's ICUs.Overall, the responding units reported a mean occupancy rate of 84% of total bed capacity and 87% of available beds. As hospital size increased, so did ICU occupancy. Nearly 17% of all of the critical care patients had been in the units for >14 days. More precisely, 49% of all responding units indicated that they had one or more ''chronic'' (> 14-day length of stay) patients. Most patients were admitted to the units from the emergency room (38%), operating room/postanesthesia care unit (22%), and the general hospital floor (16%). Neonatal units were exceptions to this observation, where most patients came from the delivery room (60%). Admission from other hospitals represented a significantly larger group of patients in the cardiac care, pediatric, and neonatal units.Respondents indicated that many of their current patients were elderly, with 43% of these patients aged 65 to 84 yrs and with 4% being greater-than-or-equal-to 85 yrs of age. The 47% of patients greater-than-or-equal-to 65 yrs of age increased to 58% when the neonatal and pediatric units were eliminated from the analyses.For all units responding to the survey, the leading primary admitting intensive care diagnoses were postoperative management, ischemic heart disorder, respiratory insufficiency/failure, and prematurity. Elimination of units predominantly treating children (pediatric and neonatal) from the analysis left ''adult' units with three primary admitting diagnoses: ischemic heart disease, postoperative management, and respiratory insufficiency/failure with variation according to specific unit type. The leading diagnoses in pediatric units were respiratory insufficiency/failure, postoperative management, and congenital abnormalities. For neonatal units, prematurity was the primary admitting diagnosis, accounting for 59% of these units' patients.Respondents reported 5.3 +/- 10.9% of patients had received cardiopulmonary resuscitation (CPR) before admission into the critical care unit. Only 6.0 +/- 11.9% of patients in these critical care units had instructions that CPR not be performed while in the unit.Conclusions: This report should be viewed as the beginning step of an effort to improve both the information base available on critical care medicine and the performance of ICUs. Our survey findings provide an introduction into the everyday workings of critical care units throughout the United States. Research is required to determine which patients will benefit from intensive care and how to efficiently utilize the vast technology we have available for them in a world with limited financial resources, an aging population, and a multiplicity of societal and ethical concerns.