Skip to main content

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


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.


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


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


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.


  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/s00134-007-0690-3

    Article  PubMed  Google 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/s00134-005-2762-6

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Guadalupe, E., Silva, E., Colombari, F. et al. Severity-adjusted resource use and outcomes of an ICU of a tertiary hospital in Sao Paulo, Brazil. Crit Care 17 (Suppl 3), P15 (2013).

Download citation

  • Published:

  • DOI:


  • Public Health
  • Mortality Rate
  • Emergency Medicine
  • Retrospective Analysis
  • Confounding Factor