Artigo Acesso aberto Produção Nacional Revisado por pares

Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study

2015; Springer Science+Business Media; Volume: 41; Issue: 12 Linguagem: Inglês

10.1007/s00134-015-4076-7

ISSN

1432-1238

Autores

Márcio Soares, Fernando A. Bozza, Derek C. Angus, André Miguel Japiassú, William N. Viana, Roberto Costa, Leonardo Brauer, Bruno Franco Mazza, Thiago Domingos Corrêa, André Luiz Baptiston Nunes, Thiago Lisboa, Fernando Colombari, Alexandre Toledo Maciel, Luciano C. P. Azevedo, Moyzes Pinto Coelho Duarte Damasceno, Haggeas S. Fernandes, Alexandre Biasi Cavalcanti, Pedro Emmanuel Alvarenga Americano do Brasil, Jeremy M. Kahn, Jorge I. Salluh,

Tópico(s)

Intensive Care Unit Cognitive Disorders

Resumo

Detailed information on organization and process of care in intensive care units (ICU) in emerging countries is scarce. Here, we investigated the impact of organizational factors on the outcomes and resource use in a large sample of Brazilian ICUs. Retrospective cohort study of 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We retrieved patients' data from an ICU quality registry and surveyed ICUs regarding structure, organization, staffing patterns, and process of care. We used multilevel logistic regression analysis to identify factors associated with hospital mortality. Efficient resource use was assessed by estimating standardized resource use and mortality rates adjusted for the SAPS 3 score. ICUs were mostly medical-surgical (79 %) and located at private hospitals (86 %). Median nurse to bed ratio was 0.20 (IQR, 0.15–0.28) and board-certified intensivists were present 24/7 in 16 (21 %) of ICUs. Multidisciplinary rounds occurred in 67 (86 %) and daily checklists were used in 36 (46 %) ICUs. Most frequent protocols focused on sepsis management and prevention of healthcare-associated infections. Hospital mortality was 14.4 %. In multivariable analysis, the number of protocols was the only organizational characteristic associated with mortality [odds ratio = 0.944 (95 % CI 0.904–0.987)]. The effects of protocols were consistent across subgroups including surgical and medical patients as well as the SAPS 3 tertiles. We also observed a significant trend toward efficient resource use as the number of protocols increased. In emerging countries such as Brazil, organizational factors, including the implementation of protocols, are potential targets to improve patient outcomes and resource use in ICUs.

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