Hariharan S, Chen D, Merritt-Charles L, Bobb N, De Freitas L, Esdelle-Thomas A, Mohamed J, Charles D, Colley K, Renaud E
Anaesthesia and Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, Eric Williams Medical Sciences Complex, Mount Hope, Trinidad and Tobago, West Indies.
West Indian Med J. 2007 Mar;56(2):144-51. doi: 10.1590/s0043-31442007000200008.
To evaluate resources and utilization of Intensive Care Units in Trinidad and Tobago.
This was a prospective observational study to evaluate Intensive Care Units (ICU) of three public and two private hospitals in Trinidad with respect to their infrastructure, process of care and patient outcome. Structure of ICUs was assessed by interviews and personal observations. A Cost Block Model was used to determine the expenditure for ICUs. The process of ICU was assessed by Therapeutic Intervention Scoring System (TISS-28). For outcome evaluation, two prognostic scoring systems namely Simplified Acute Physiology Score (SAPS II) and Paediatric Index of Mortality-2 (PIM-2) were used
The total number of ICU beds was 27. The overall bed occupancy was 66.2%. One hundred and eighteen patients consecutively admitted to ICU during a two-month period were enrolled for process and outcome evaluation. The overall median age of patients was 44 years [Interquartile range (IQR) 25, 59]. The mean cost per patient in the public hospitals was TT $64,746 compared to $77,000 in a private hospital. The average total daily TISS per patient was 27.01 +/- 5.4 (SD). The median length of stay was five days (IQR 2, 9). The overall predicted mortality was 32.9%, the observed mortality was 29.7% and thus the standardized mortality ratio (SMR) was 0.9.
The overall bed availability in ICUs with respect to Trinidad and Tobago's population and case-mix is low compared to developed countries, although the process of ICU care is comparable. Outcome of patients was good in terms of risk-adjusted mortality. The study highlights the need to further increase bed-strength and optimize the resource utilization of ICUs in Trinidad and Tobago.
评估特立尼达和多巴哥重症监护病房的资源及利用情况。
这是一项前瞻性观察性研究，旨在评估特立尼达的三家公立医院和两家私立医院的重症监护病房（ICU）的基础设施、护理流程及患者结局。通过访谈和个人观察对ICU的结构进行评估。采用成本块模型确定ICU的支出。通过治疗干预评分系统（TISS-28）评估ICU的护理流程。对于结局评估，使用了两种预后评分系统，即简化急性生理学评分（SAPS II）和小儿死亡率指数-2（PIM-2）。
ICU床位总数为27张。总体床位占用率为66.2%。在两个月的时间里，连续入住ICU的118名患者被纳入护理流程和结局评估。患者的总体中位年龄为44岁[四分位间距（IQR）25，59]。公立医院每位患者的平均费用为64,746特立尼达和多巴哥元，而私立医院为77,000特立尼达和多巴哥元。每位患者每天的平均TISS总量为27.01±5.4（标准差）。中位住院时间为5天（IQR 2，9）。总体预测死亡率为32.9%，观察到的死亡率为29.7%，因此标准化死亡率（SMR）为0.9。
与发达国家相比，就特立尼达和多巴哥的人口及病例组合而言，ICU的总体床位可用性较低，尽管ICU护理流程具有可比性。就风险调整后的死亡率而言，患者结局良好。该研究强调了在特立尼达和多巴哥进一步增加床位数量并优化ICU资源利用的必要性。
