Intensivist-to-bed ratio - Association with outcomes in the medical ICU
Intensivist-to-bed ratio - Association with outcomes in the medical ICU
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DOI：
10.1378/chest.128.2.567
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发表时间：
2005-08-01
期刊：
影响因子：
9.6
通讯作者：
Afessa, B
中科院分区：
文献类型：
--
作者：
Dara, SI;Afessa, B
目的：随着重症监护病床数量的增加，重症监护医生的短缺以及来自购买者的压力，需要定义最佳的重症监护与ICU病床比例。本研究的目的是确定重症监护室床位比与内科ICU患者的预后之间是否存在任何关联。设计：回顾性队列研究。设置：三级医疗中心。患者：2001年12月8日至2003年7月14日期间内科ICU收治的所有重症患者。干预：无。测量：人口统计学、APACHE（急性生理学和慢性健康评价）III预测死亡率、ICU住院时间（LOS）、医院LOS以及ICU和医院死亡率。根据重症监护医师与ICU床位比1：7.5、1：9.5、1：12和1：15确定了4个时间段。进行回归分析以开发定制模型来预测ICU和医院的LOS和死亡率。ICU LOS比，定义为观察到的预测LOS的比率，和标准化死亡率比（SMR）计算为每四个periods.Results：共2,492例患者被纳入研究。四个阶段的ICU入院时疾病严重程度无差异。重症监护室与ICU床位比为1：15时，平均ICU LOS比比其他时间段更长。ICU和医院STMR没有显着差异四个periods.Conclusion：重症监护病房病床比的差异，范围从1：7.5到1：15，与ICU或医院死亡率的差异无关。然而，1：15的比率与ICU LOS增加相关。
Objective: With an increasing number of critical care beds, a shortage of critical care physicians, and pressure from purchasers, there is a need to define the optimal intensivist-to-ICU bed ratio. The objective of this study was to determine if there are any associations between the intensivist-to-ICU bed ratio and the outcome of patients admitted to the medical ICU.Design: Retrospective cohort study.Setting: A tertiary care medical center.Patients: All critically ill patients admitted to a medical ICU between December 8, 2001, and July 14,2003.Interventions: None.Measurements: Demographics, APACHE (acute physiology and chronic health evaluation) III-predicted mortality, ICU length of stay (LOS), hospital LOS, and ICU and hospital mortality rates. Four time periods based on intensivist-to-ICU bed ratios of 1;7.5, 1:9.5, 1:12, and 1:15 were identified. Regression analyses were performed to develop customized models to predict ICU and hospital LOS and mortality. The ICU LOS ratio, defined as the ratio of the observed to predicted LOS, and standardized mortality ratio (SMR) were calculated for each of the four periods.Results: A total of 2,492 patients were included in the study. There was no difference in the severity of illness at the time of ICU admission among the four periods. The mean ICU LOS ratio was longer for an intensivist-to-ICU bed ratio of 1: 15 compared to the other periods. The ICU and hospital STMR did not differ significantly among the four periods.Conclusion: Differences in intensivist-to-ICU bed ratios, ranging from 1:7.5 to 1:15, were not associated with differences in ICU or hospital mortality. However, a ratio of 1:15 was associated with increased ICU LOS.