UCL/UCLH Surgical Outcomes Research Centre, Centre for Perioperative Medicine, Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Health Services Research Centre, National Institute of Academic Anaesthesia, Royal College of Anaesthetists, London, UK.
Gold Coast University Hospital, Southport, Queensland, Australia.
Br J Anaesth. 2019 Apr;122(4):460-469. doi: 10.1016/j.bja.2018.12.026. Epub 2019 Feb 8.
Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.
We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ. Hospital- and ward-level data were collected, including bed numbers, tertiary services offered, presence of an emergency department, ward staffing levels, and the availability of critical care facilities.
We received responses from 257 UK (response rate: 97.7%), 35 Australian (response rate: 32.7%), and 17 NZ (response rate: 94.4%) hospitals (total 309). Of these hospitals, 91.6% reported on-site ICU or HDU facilities. UK hospitals reported fewer critical care beds per 100 hospital beds (median=2.7) compared with Australia (median=3.7) and NZ (median=3.5). Additionally, 31.1% of hospitals reported having high-acuity beds to which high-risk patients were admitted for postoperative management, in addition to standard ICU/HDU facilities. The estimated numbers of critical care beds per 100 000 population were 9.3, 14.1, and 9.1 in the UK, Australia, and NZ, respectively. The estimated per capita high-acuity bed capacities per 100 000 population were 1.2, 3.8, and 6.4 in the UK, Australia, and NZ, respectively.
Postoperative critical care resources differ in the UK, Australia, and NZ. High-acuity beds may have developed to augment the capacity to deliver postoperative critical care.
高危术后患者入住重症监护病房的决策可能受到资源可用性的影响。我们旨在量化英国、澳大利亚和新西兰（NZ）医院的成人 ICU/高依赖病房（ICU/HDU）容量，并确定和描述能够在 ICU/HDU 环境之外管理高危患者的额外“高重症”床位。
我们使用改良 Delphi 共识方法设计了一项调查，通过英国、澳大利亚和 NZ 的调查员网络进行了传播。收集了医院和病房级别的数据，包括床位数量、提供的三级服务、急诊部门的存在、病房人员配备水平以及重症监护设施的可用性。
我们收到了来自英国 257 家（回应率：97.7%）、澳大利亚 35 家（回应率：32.7%）和新西兰 17 家（回应率：94.4%）医院（共 309 家）的回应。这些医院中有 91.6%报告了现场 ICU 或 HDU 设施。与澳大利亚（中位数=3.7）和新西兰（中位数=3.5）相比，英国医院每 100 张病床报告的重症监护床位较少（中位数=2.7）。此外，31.1%的医院报告说，除了标准的 ICU/HDU 设施外，还有高重症床位可用于收治高危患者进行术后管理。英国、澳大利亚和新西兰每 10 万人的重症监护床位估计数分别为 9.3、14.1 和 9.1。英国、澳大利亚和新西兰每 10 万人的高重症床位容量估计数分别为每 10 万人 1.2、3.8 和 6.4。
英国、澳大利亚和新西兰的术后重症监护资源不同。高重症床位的发展可能是为了增加提供术后重症监护的能力。
