Variability in outcome and resource use in intensive care units

Rothen, Hans U; Stricker, Kay; Einfalt, Johanna; Bauer, Peter; Metnitz, Philip G H; Moreno, Rui P; Takala, Jukka (2007). Variability in outcome and resource use in intensive care units. Intensive care medicine, 33(8), pp. 1329-36. Berlin: Springer-Verlag 10.1007/s00134-007-0690-3

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OBJECTIVE: To examine variability in outcome and resource use between ICUs. Secondary aims: to assess whether outcome and resource use are related to ICU structure and process, to explore factors associated with efficient resource use. DESIGN AND SETTING: Cohort study, based on the SAPS 3 database in 275 ICUs worldwide. PATIENTS: 16,560 adults. MEASUREMENTS AND RESULTS: Outcome was defined by standardized mortality rate (SMR). Standardized resource use (SRU) was calculated based on length of stay in the ICU, adjusted for severity of acute illness. Each unit was assigned to one of four groups: "most efficient" (SMR and SRU < median); "least efficient" (SMR, SRU > median); "overachieving" (low SMR, high SRU), "underachieving" (high SMR, low SRU). Univariate analysis and stepwise logistic regression were used to test for factors separating "most" from "least efficient" units. Overall median SMR was 1.00 (IQR 0.77-1.28) and SRU 1.07 (0.76-1.58). There were 91 "most efficient", 91 "least efficient", 47 "overachieving", and 46 "underachieving" ICUs. Number of physicians, of full-time specialists, and of nurses per bed, clinical rounds, availability of physicians, presence of emergency department, and geographical region were significant in univariate analysis. In multivariate analysis only interprofessional rounds, emergency department, and geographical region entered the model as significant. CONCLUSIONS: Despite considerable variability in outcome and resource use only few factors of ICU structure and process were associated with efficient use of ICU. This suggests that other confounding factors play an important role.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Rothen, Hans Ulrich; Stricker, Kay and Takala, Jukka

ISSN:

0342-4642

ISBN:

17541552

Publisher:

Springer-Verlag

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 14:55

Last Modified:

23 Oct 2019 12:45

Publisher DOI:

10.1007/s00134-007-0690-3

PubMed ID:

17541552

Web of Science ID:

000248301200005

BORIS DOI:

10.7892/boris.23556

URI:

https://boris.unibe.ch/id/eprint/23556 (FactScience: 42385)

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