Barbieri S, Feltracco P, Michieletto E, Basso I, Spagna A, Giron G
Department of Pharmacology and Anesthesia E. Meneghetti, University of Padua, Padua, Italy.
Minerva Anestesiol. 2003 Jul-Aug;69(7-8):625-34, 634-9.
This study aims to evaluate the management of intensive care beds according to the demands received by the SUEM 118 of Padua. It has been carried out by examining the reports drawn up by SUEM physicians from October 1996 to December 2001. The study rated the number of patients for whom an admission to the Intensive Care Unit (ICU) was required, according to the specific clinical situation at the moment of the request. A secondary objective was to evaluate if the critically ill patients had been admitted and treated in the most appropriate medical facility.
The research is based on 7 087 reports concerning a population of adult and pediatric patients for whom an ICU bed was required in the period previously mentioned. For each report, it analyses the following data (keeping them anonymous): date of demand, main pathology and severity of clinical condition, sex and age, provenence and destination.
Even though the number of annual demands for an ICU bed made to SUEM Central 118 has remained unchanged (approximately 1 350 per year), the number of beds made available in the operating rooms of the Hospital of Padua markedly increased. What has been experienced so far, and the data collected in this study has revealed, was that the requests for an intensive treatment for the overall population (hospitalized and non hospitalized) increased disproportionally in relation to the availability of ICU beds. In fact, the total number of hospitalizations in the different ICUs rose steadily year by year (from 3 495 in 1996 to 4 640 in 2001).
The Hospital of Padua is a landmark center for patients who need specialized treatment. It is therefore important to increase the assistance and safety standards of its ICUs. In recent years there has been a great need for specialized ICUs either for more aggressive procedures (neurosurgical, cardiosurgical, respiratory, cardiologic, etc.) or for the increased use of adequate and invasive treatment for advanced diseases. The available resources of ICU beds should be more rationally distributed between the peripheral and the Regional Hospitals, since the activation of an ICU bed in the operating theatre is a valid, transient option.
本研究旨在根据帕多瓦急救调度中心118接到的需求来评估重症监护病床的管理情况。研究通过审查急救调度中心医生在1996年10月至2001年12月期间撰写的报告来开展。该研究根据请求时的具体临床情况,对需要入住重症监护病房(ICU)的患者数量进行了评级。第二个目标是评估重症患者是否在最合适的医疗机构得到收治和治疗。
该研究基于7087份报告,这些报告涉及上述期间需要ICU床位的成年和儿科患者群体。对于每份报告,分析以下数据(保持匿名):需求日期、主要病理和临床状况的严重程度、性别和年龄、来源和去向。
尽管每年向急救调度中心118提出的ICU床位需求数量保持不变(每年约1350例),但帕多瓦医院手术室提供的床位数量显著增加。到目前为止所经历的情况以及本研究收集的数据表明,总体人群(住院和非住院)对强化治疗的需求相对于ICU床位的可用性不成比例地增加。事实上,不同ICU的住院总数逐年稳步上升(从1996年的3495例增至2001年的4640例)。
帕多瓦医院是需要专科治疗患者的标志性中心。因此,提高其ICU的护理和安全标准很重要。近年来,对专科ICU的需求很大,这要么是为了进行更积极的手术(神经外科、心脏外科、呼吸科、心脏病科等),要么是为了增加对晚期疾病的充分和侵入性治疗的使用。ICU床位的可用资源应在外围医院和地区医院之间更合理地分配,因为在手术室启用ICU床位是一个有效的临时选择。