[Comparison of the structures of the medical staff and the operation situations of the departments of critical care medicine between the provincial and county level hospitals of Guizhou Province in 2017].

OBJECTIVE

To understand the situations of departments of intensive care units (ICUs) of different level hospitals in Guizhou Province, and to provide directions and evidences for improving quality control in critical care medicine.

METHODS

A county-level hospital and a provincial-level hospital's comprehensive ICU in Guizhou Province were selected to record and analyze and compare the structural indicators, patient admission and transfer, disease distribution, ventilator associated pneumonia (VAP), intravascular catheter related blood stream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) of the two hospitals' comprehensive ICU in 2017.

RESULTS

The ICU of the People's Hospital of Suiyang County (county hospital) was found in 2012, and the ICU of the Affiliated Hospital of Guizhou Medical University (provincial hospital) was found in 1994. Until 2017, there were 10 and 46 beds, 6 (all of them hold bachelor's degree) and 18 physicians (6 of them hold PhD, 5 of them hold master's degree, 7 of them hold bachelor's degree), 17 (4 of them hold bachelor's degree, 13 of them hold college degree or graduated from secondary school) and 69 nurses (2 of them hold master's degree, 53 of them hold bachelor's degree, 14 of them hold college degree or graduated from secondary school) in the two ICUs respectively, there were significant differences in the education background of the physicians and nurses between the two ICUs (both P < 0.01). During 2017, 471 cases were admitted to the ICU of the county hospital while 1 633 cases were admitted to the ICU of the provincial hospital. Compared with the ICU of the provincial hospital, the ratio of the patients with acute physiology and chronic health evaluation II (APACHE II) ≥ 15 at admission was lower (74.8% vs. 85.1%, P < 0.01), the ratio of direct admission was higher (30.8% vs. 17.4%, P < 0.01), the ratio of the patients admitted to the ICU more than once was lower (0.8% vs. 5.0%, P < 0.01), the ratio of the patients whose the length of ICU stay less than 24 hours was higher (51.6% vs. 13.7%, P < 0.01), the ratio of the patients whose the length of ICU stay more than 28 days was lower (1.1% vs. 2.9%, P < 0.05), the ratio of the patients discharged against-advice (25.5% vs. 20.5%, P < 0.05) was higher, the ratio of the patients transferred to other hospitals was higher (5.1% vs. 0.3%, P < 0.05), and the ICU mortality was lower (4.0% vs. 13.9%, P < 0.01) in the ICU of the county hospital. The top three kinds of diseases treated in the ICU of the county hospital were brain injury (27.4%), trauma (19.1%) and toxication (6.8%); while in the ICU of the provincial hospital were brain injury (18.6%), sepsis (16.2%) and severe acute pancreatitis (4.8%). In addition, the incidences of VAP, CRBSI and CAUTI in the ICU of the county hospital were 10.0/1 000 ventilator days, 1.4/1 000 catheter days, 0.5/1 000 catheter days; while in the ICU of the provincial hospital were 5.8/1 000 ventilator days, 2.0/1 000 catheter days, 3.7/1 000 catheter days, respectively.

CONCLUSIONS

There are short of physicians and nurses in the ICU of the provincial and county hospitals in Guizhou Province, and the educational level of the medical staff in the ICU of the county hospital is relatively low. Moreover, there were significant differences in the admissions and treatments and the outcomes of the critically ill patients between the two ICUs. The characteristics of the ICUs of county hospitals should be fully considered when the quality control of critical care medicine and continuing medical education are done.