重症监护病房容量紧张的指标：系统评价。
Indicators of intensive care unit capacity strain: a systematic review.
机构信息
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440 - 112th Street, Edmonton, AB, T6G 2B7, Canada.
School of Public Health, University of Alberta, Edmonton, AB, Canada.
出版信息
Crit Care. 2018 Mar 27;22(1):86. doi: 10.1186/s13054-018-1975-3.
BACKGROUND
Strained intensive care unit (ICU) capacity represents a fundamental supply-demand mismatch in ICU resources. Strain is likely to be influenced by a range of factors; however, there has been no systematic evaluation of the spectrum of measures that may indicate strain on ICU capacity.
METHODS
We performed a systematic review to identify indicators of strained capacity. A comprehensive peer-reviewed search of MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science Core Collection was performed along with selected grey literature sources. We included studies published in English after 1990. We included studies that: (1) focused on ICU settings; (2) included description of a quality or performance measure; and (3) described strained capacity. Retrieved studies were screened, selected and extracted in duplicate. Quality was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Analysis was descriptive.
RESULTS
Of 5297 studies identified in our search; 51 fulfilled eligibility. Most were cohort studies (n = 39; 76.5%), five (9.8%) were case-control, three (5.8%) were cross-sectional, two (3.9%) were modeling studies, one (2%) was a correlational study, and one (2%) was a quality improvement project. Most observational studies were high quality. Sixteen measures designed to indicate strain were identified 110 times, and classified as structure (n = 4, 25%), process (n = 7, 44%) and outcome (n = 5, 31%) indicators, respectively. The most commonly identified indicators of strain were ICU acuity (n = 21; 19.1% [process]), ICU readmission (n = 18; 16.4% [outcome]), after-hours discharge (n = 15; 13.6% [process]) and ICU census (n = 13; 11.8% [structure]). There was substantial heterogeneity in the operational definitions used to define strain indicators across studies.
CONCLUSIONS
We identified and characterized 16 indicators of strained ICU capacity across the spectrum of healthcare quality domains. Future work should aim to evaluate their implementation into practice and assess their value for evaluating strategies to mitigate strain.
SYSTEMATIC REVIEW REGISTRATION
This systematic review was registered at PROSPERO (March 27, 2015; CRD42015017931 ).
背景
紧张的重症监护病房（ICU）容量代表了 ICU 资源供需之间的根本不匹配。压力可能受到一系列因素的影响；然而，对于可能表明 ICU 容量紧张的各种措施，尚未进行系统评估。
方法
我们进行了一项系统评价，以确定容量紧张的指标。对 MEDLINE、EMBASE、CINAHL、Cochrane 图书馆和 Web of Science 核心合集进行了全面的同行评审搜索，并结合了选定的灰色文献来源。我们纳入了 1990 年后以英文发表的研究。我们纳入的研究：（1）专注于 ICU 环境；（2）包括质量或绩效衡量标准的描述；（3）描述了紧张的容量。检索到的研究进行了重复筛选、选择和提取。使用纽卡斯尔-渥太华质量评估量表（NOS）评估质量。分析是描述性的。
结果
在我们的搜索中确定了 5297 项研究；51 项符合入选标准。大多数是队列研究（n = 39；76.5%），5 项（9.8%）是病例对照研究，3 项（5.8%）是横断面研究，2 项（3.9%）是建模研究，1 项（2%）是相关性研究，1 项（2%）是质量改进项目。大多数观察性研究质量较高。确定了 16 项旨在表明压力的措施，共出现 110 次，并分别归类为结构（n = 4，25%）、过程（n = 7，44%）和结果（n = 5，31%）指标。压力最常见的指标是 ICU 严重程度（n = 21；19.1%[过程]）、ICU 再入院（n = 18；16.4%[结果]）、下班后出院（n = 15；13.6%[过程]）和 ICU 人数（n = 13；11.8%[结构]）。在研究之间，用于定义压力指标的操作定义存在很大的异质性。
结论
我们在整个医疗保健质量领域确定并描述了 16 个 ICU 容量紧张的指标。未来的工作应旨在评估将其实施到实践中的情况，并评估其评估减轻压力策略的价值。
系统审查注册
本次系统审查于 2015 年 3 月 27 日在 PROSPERO（CRD42015017931）注册。
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