Liu Xu, Wang Difen, Xiong Jie, Tang Yan, Cheng Yumei, Chen Qimin
Department of Critical Care Medicine, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China.
the Quality Control Center of Critical Care Medicine of Guizhou Province, Guiyang 550004, Guizhou, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Feb;32(2):230-234. doi: 10.3760/cma.j.cn121430-20191225-00043.
To know the critical care resources of the different class-hospitals in Guizhou Province, China, and to provide the direction and evidence for quality improvement and discipline construction of critical care medicine in Guizhou Province.
The resource status of the departments of intensive care unit (ICU) in Guizhou Province was obtained through form filling and/or field investigation. The forms were filled and submitted from May 2017 to February 2018, and the field investigation (some of the hospitals) was carried out in March 2018. The data of hospitals in Guizhou Province in 2018, was obtained from the official website of Health Committee of Guizhou Province, which was released online on November 28th, 2019. The obtained data were summarized and analyzed according to different aspects such asthe status of ICU construction, main equipment configuration and technology implementation.
There were 39 third-class hospitals and 77 second-class hospitals included in this study, which accounted for 76.5% (39/51) of third-class public hospitals and 50.0% (77/154) of second-class public hospitals respectively. Among them, there were 86.8% (33/38) of third-class general hospitals and 50.4% (69/137) of second-class general hospitals respectively. In terms of ICU construction, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were established earlier [years: 2011 (2008, 2012) vs. 2013 (2011, 2015), P < 0.01], had more ICU beds, doctors and nurses [15 (11, 20) vs. 8 (6, 10), 9 (8, 11) vs. 6 (5, 7), 25 (20, 41) vs. 15 (12, 19), respectively, all P < 0.01]. However, there were no significant differences regarding the doctor-bed ratio and the nurse-bed ratio in ICUs between second-class hospitals and third-class hospitals. In terms of main equipment configuration, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals had more ventilators, higher ratio of ventilators to beds, more infusion pumps, higher ratio of infusion pumps to beds, more monitor, gastrointestinal nutrition pumps and single rooms, and higher proportion of ICUs equipped with negative pressure rooms [ventilators: 14 (10, 18) vs. 6 (4, 8), ratio of ventilators to beds: 1.0 (0.7, 1.1) vs. 0.8 (0.6, 1.0), infusion pumps: 10 (6, 20) vs. 5 (3, 8), ratio of infusion pumps to beds: 0.8 (0.0, 1.0) vs. 0.0 (0.0, 0.4), monitor: 18 (13, 24) vs. 9 (6, 12), gastrointestinal nutrition pumps: 2 (1, 5) vs. 1 (0, 3), single rooms: 2 (1, 3) vs. 1 (0, 3), proportion of ICUs equipped with negative pressure rooms: 53.8% (21/39) vs. 31.5% (23/73), respectively, all P < 0.05]. Furthermore, there were higher proportions of ICUs equipped with portable ventilator, pulse indicator continuous cardiac output monitoring (PiCCO), intra-aortic balloon pump (IABP), extra-corporeal membrane oxygenation (ECMO), B ultrasound machine, bronchoscope, pressure of end-tidal carbondioxide (PCO) monitoring, bispectral index (BIS) monitoring, bedside gastroscopy, the apparatus used for the prevention of deep vein thrombosis of lower extremity in third-class hospitals than in second-class hospitals [portable ventilator: 86.7% (26/30) vs. 59.6% (28/47), 43.3% (13/30) vs. 1.5% (1/66), 14.3% (4/28) vs. 0% (0/65), 10.7% (3/28) vs. 0% (0/65), 62.5% (20/32) vs. 37.3% (25/67), 97.1% (33/34) vs. 63.6% (42/66), 60.6% (20/33) vs. 28.4% (19/67), 17.2% (5/29) vs. 0% (0/65), 27.6% (8/29) vs. 1.5% (1/65), 77.4% (24/31) vs. 52.3% (34/65), respectively, all P < 0.05]. In terms of skills development, there were more ICUs carried out intracranial pressure monitoring, abdominal pressure monitoring, ultrasound diagnosis, bronchoscope examination and treatment and blood purification in third-class hospitals than in second-class hospitals [31.6% (12/38) vs. 14.7% (11/75), 75.7% (28/37) vs. 38.6% (27/70), 61.5% (24/39) vs. 24.3% (18/74), 89.7% (35/39) vs. 45.9% (34/74), 92.3% (36/39) vs. 48.6% (36/74), respectively, all P < 0.05].
The data were mainly derived from public general hospitals in Guizhou Province. Compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were founded earlier and larger, had better hardware configuration and could carry out more skills. However, the human resource situations were similar between second-class hospitals and third-class hospitals. Both second-class hospitals and third-class hospitals have a need to improve the allocation of manpower and equipment and expand various skills in ICUs, while it is more urgent for second-class hospitals.
了解我国贵州省不同等级医院的重症监护资源，为贵州省重症医学的质量提升和学科建设提供方向及依据。
通过填表和/或实地调研获取贵州省重症监护病房（ICU）的资源状况。表格填写于2017年5月至2018年2月期间提交，实地调研（部分医院）于2018年3月开展。贵州省2018年医院的数据来自贵州省卫生健康委员会官方网站，于2019年11月28日在线发布。将获取的数据按照ICU建设状况、主要设备配置及技术开展等不同方面进行汇总分析。
本研究纳入39家三级医院和77家二级医院，分别占三级公立医院的76.5%（39/51）和二级公立医院的50.0%（77/154）。其中，三级综合医院占86.8%（33/38），二级综合医院占50.4%（69/137）。在ICU建设方面，与二级医院的ICU相比，三级医院的ICU成立时间更早[年份：2011（2008，2012）vs. 2013（2011，2015），P<0.01]，拥有更多的ICU床位、医生和护士[分别为15（11，20）vs. 8（6，10），9（8，11）vs. 6（5，7），25（20，41）vs. 15（12，19），均P<0.01]。然而，二级医院和三级医院ICU的医生床位比和护士床位比无显著差异。在主要设备配置方面，与二级医院的ICU相比，三级医院的ICU拥有更多的呼吸机、更高的呼吸机床位比、更多的输液泵、更高的输液泵床位比、更多的监护仪、胃肠营养泵和单人病房，配备负压病房的ICU比例更高[呼吸机：14（10，18）vs. 6（4，8），呼吸机床位比：1.0（0.7，1.1）vs. 0.8（0.6，1.0），输液泵：10（6，20）vs. 5（3，8），输液泵床位比：0.8（0.0，1.0）vs. 0.0（0.0，0.4），监护仪：18（13，24）vs. 9（6，12），胃肠营养泵：2（1，5）vs. 1（0，3），单人病房：2（1，3）vs. 1（0，3），配备负压病房的ICU比例：53.8%（21/39）vs. 31.5%（23/73），均P<0.05]。此外，三级医院配备便携式呼吸机、脉搏指示连续心输出量监测（PiCCO）、主动脉内球囊反搏（IABP）、体外膜肺氧合（ECMO）、B超机、支气管镜、呼气末二氧化碳分压（PCO）监测、脑电双频指数（BIS）监测、床边胃镜、下肢深静脉血栓预防装置的ICU比例高于二级医院[便携式呼吸机：86.7%（26/30）vs. 59.6%（28/47），43.3%（13/30）vs. 1.5%（1/66），14.3%（4/28）vs. 0%（0/65），10.7%（3/28）vs. 0%（0/65），62.5%（20/32）vs. 37.3%（25/67），97.1%（33/34）vs. 63.6%（42/66），60.6%（20/33）vs. 28.4%（19/67），17.2%（5/29）vs. 0%（0/65），27.6%（8/29）vs. 1.5%（1/65），77.4%（24/31）vs. 52.3%（34/65），均P<0.05]。在技术开展方面，三级医院开展颅内压监测、腹压监测、超声诊断、支气管镜检查及治疗和血液净化的ICU比二级医院更多[31.6%（12/38）vs. 14.7%（11/75），75.7%（28/37）vs. 38.6%（27/70），61.5%（24/39）vs. 24.3%（18/74），89.7%（35/39）vs.
