Organization and staffing of intensive care units in Brazil

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Introduction

The `1° Brazilian Census of ICUs' was developed by the Brazilian Society of Intensive Care (Associação Medicina Intensiva Brasileira - AMIB) to delineate the ICU profile in this country.

Methods

Data collection was done through a questionnaire sent to all hospitals. Through a software package, these data were gathered, creating a comprehensive database with ICU organizational and resource information.

Results

To be accredited as a training center by AMIB, the ICU must run a special program under specific conditions. At this census, 31.3% of the ICUs had a critical care training program but only 10.4% were accredited by AMIB. Despite the continental dimension of the country and the large number of units, they are concentrated (79%) in south-east region. In Brazil, critical care medicine has largely been considered a second specialty by the physician: 61.1% were clinicians, 22.6% pediatricians, 9.8% surgeons and only 3.1% anesthesiologists. Just 23% of the intensivists are certified as specialists by AMIB. 72.9% of the physicians work on duty (12 or 24 h shifts) and 18.1% work on a daily basis. 84.7% of the respondent ICUs had a chief-nurse exclusive to the ICU and 67.4% had therapists 12 h per day. 71.5% performed scientific meetings with ICU staff regularly. 51.5% had a computerized registry of admitted patients but only 33.4% classified admitted patients according to a scoring system. 74.8% had written admission and procedures rules and 64.4% had written therapeutic orientation rules. 83.3% performed evaluation of adverse patient occurrences and 53.1% of the ICUs elaborated an annual report about their activities.

Conclusion

This study was the first step to recognize the structure and distribution of ICUs and exposed facts that must be improved, for instance, the need to increase the number of specialists through the creation of new training centers all over the country.