Volume 17 Supplement 3

Seventh International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

Severity-adjusted resource use and outcomes of an ICU of a tertiary hospital in Sao Paulo, Brazil

  • EGL Guadalupe1,
  • E Silva1,
  • F Colombari1, 2,
  • A Serpa Neto1 and
  • A Pardini1
Critical Care201317(Suppl 3):P15

https://doi.org/10.1186/cc12631

Published: 19 June 2013

Introduction

Quality management in intensive care currently emphasizes outcome linked to optimization of resources. Intensive care medicine focuses on the most severe patients in the hospital and therefore high resource consumption, making its management a challenge. Of many parameters to estimate utilization of resources, only length of stay (LOS) is systematically collected. Therefore, severity-adjusted resource use (SRU) can be an important tool for estimating resource consumption in an ICU. The objective of this study was to evaluate the resource consumption by SRU in the adult ICU of the Hospital Israelita Albert Einstein, São Paulo, Brazil, in patients admitted during the first half of 2012.

Methods

Retrospective analysis of 1,441 patients admitted during the first half of 2012 to a tertiary hospital in São Paulo, Brazil. Patients were divided into nine categories based on SAPS 3 as shown in Table 1, and then the standardized mortality rate (SMR), the quotient of observed to predicted mortality, was calculated. SRU was calculated for each stratum of SAPS 3 by dividing the LOS in the ICU for all patients by the number of survivors. The ICUs' SAPS 3 database was considered to standardize SRU. The amount of resources used was measured as the number of days per survival. Readmitted patients over 24 hours were excluded.
Table 1

SAPS 3 based on categories of severity

Category

1

2

3

4

5

6

7

8

9

SAPS 3 points

0 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 to 84

85 to 94

>95

Results

A total of 1,441 patients were analyzed. The male proportion, age, LOS and SAPS 3 averages were 57.4%, 65 ± 18 years, 3.87 ± 5.95 days and 45.14 ± 15.9, respectively. The main results are shown in Table 2. No patient died of category 2.
Table 2

Data with SAPS 3, SRU and SMR

Category

SAPS 3 mean(SD)

Patients

Survivors

Σ days LOS (all patients)

SRU

SRU standardized

SMR

1

19.75 ± 4.08

112

111

161

1.45

0.03

1.1

2

30.36 ± 2.92

335

335

673

2.01

0.13

0

3

39.31 ± 2.77

350

346

823

2.37

0.16

0.13

4

49.18 ± 2.86

304

295

1,087

3.68

0.22

0.13

5

59.06 ± 2.79

202

174

1,155

6.64

0.23

0.3

6

68.77 ± 2.79

86

73

795

10.89

0.16

0.22

7

78.5 ± 2.45

34

18

251

13.94

0.05

0.56

8

88.54 ± 2.99

13

7

86

12.28

0.02

0.5

9

97.8 ± 4.21

5

2

16

8

0.003

0.62

Total

45.14 ± 15.9

1,441

1,361

5,047

3.72

0.13

0.24

Conclusion

According to these data, the analyzed ICU appears to be very efficient for outcomes standardized by SAPS 3 and utilization of resources by SRU. However, confounding factors should be considered: decalibration SAPS 3 for this ICU and the presence of a step-down unit in the hospital.

Authors’ Affiliations

(1)
Hospital Israelita Albert Einstein
(2)
Hospital Alemão Oswaldo Cruz

References

  1. Rothen HU, Stricker K, Einfalt J, et al.: Variability in outcome and resource use in intensive care units. Intensive Care Med 2007, 33: 1329-1336. 10.1007/s00134-007-0690-3View ArticlePubMedGoogle Scholar
  2. Moreno RP, Metnitz PGH, Almeida E, et al.: SAPS 3 - from evaluation of the patient to evaluation of the intensive care unit. Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 2005, 31: 1336-1355. 10.1007/s00134-005-2762-6PubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Guadalupe et al; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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