Chang Xiaowan, Qin Bingyu, Liang Xinliang, Hu Xianzeng, Wang Shouzhen, Ye Yingjun, Yang Yongguang, Wang Yuebo
People's Hospital of Henan Province, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou 450003, Henan, China.
Ruzhou First People's Hospital, Ruzhou 467500, Henan, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Dec;32(12):1511-1516. doi: 10.3760/cma.j.cn121430-20200408-00260.
To investigate the present status of intensive care unit (ICU) in the county-level general hospitals of Henan Province and provide basis for improving the construction level and rational allocation of medical resources of ICU.
According to The guidelines for the construction and management of critical care medicine (trial implementation) issued by National Health Commission (NHC) (hereinafter referred as the guidelines), a cross-sectional survey was conducted on the present status of ICU in 93 county-level general hospitals in Henan Province in 2018 by using a self-designed questionnaire concerning this topic. The survey included the basic information of ICU (establishment time, organization and management mode, development of special departments in ICU, construction of key disciplines), scale and staffing allocation and training, and the equipment and technology development situation in ICU.
The basic aspects of ICU situation were as follows: firstly, the establishment time: the ICU of county-level general hospitals in Henan Province started relatively late. The survey showed that all the 93 hospitals had set up ICU, of which the earliest was the ICU of Xunxian People's Hospital in 1989, only 4 county-level general hospitals established their ICUs before 2000, and 34 before 2009. Secondly, the management mode: the proportion of ICU closely managed was accounting for 68.82% (64/93), while semi-open management was 18.28% (17/93), and 12.90% (12/93) hospitals still adopted the open management mode. Thirdly, development of specialized ICU and construction of key disciplines: comprehensive ICUs were founded in 86 hospitals, and the proportions of specialized ICUs such as neonatal ICU, emergency ICU and coronary heart disease care unit (CCU) were higher than other kinds of special department; the ICUs of 8 hospitals were the key discipline of Henan Provincial Health Commission, and the ICUs of 9 hospitals were the discipline of Municipal Health Commission. Scale and staffing of ICU: a total of 2 189 ICU beds were opened in 93 county-level general hospitals. The utilization rate reaching the targets of ICU beds and the compliance rate of ICU bed area per bed were relatively high, 76.34% and 80.64%, while the compliance rates of ICU doctors/ICU beds, ICU nurses/ICU beds were low, which were 8.60% and 7.52% respectively, indicating that the clinicians and nursing facilities were insufficient. There were 1 tertiary hospital, 76 secondary-A hospitals and 16 secondary-B hospitals in this survey. Compared with secondary-B hospitals in the total number of beds (sheets: 922.22±285.99 vs. 636.75±258.84) and ICU beds (sheets: 25.28±21.15 vs. 14.63±6.89), the secondary-A hospitals were significantly higher (all P < 0.01), and the rate of bed use compliance of secondary-A hospitals was significantly higher than that in secondary-B hospitals [81.6% (62/76) vs. 50.0% (8/16), P < 0.01]. In terms of staffing, the proportion of clinicians and nurses with elementary titles was the highest, the proportion of full-time senior professional titles was relatively low, the proportion of doctors with bachelor's degree was the highest, and that of nurses with junior college degree was the highest. In personnel training, the hospitals surveyed had sent the doctors and nurses mostly to participate in the continuing education and training of critical care medicine at or above the provincial level for 745 person-times and 1 156 person-times, and there were in the mean for 8 and 12 person-times in each hospital, respectively. In terms of equipment configuration and technology development of ICU, mostly the equipment in ICU of county-level general hospitals consisted of microinjection pump, monitor, infusion pump, invasive ventilator, expectorant machine, etc. but the overall equipment was insufficient. Although an extracorporeal membrane oxygenation (ECMO) equipment was introduced in one hospital, it had not been carried out clinically. All county-level general hospitals in Henan Province had set up ICUs, but there were gaps between the compliance rates of many indicators and the requirements of the guidelines, and the medical personnel and equipment were relatively insufficient.
The ICUs of county-level general hospitals in Henan Province have developed rapidly in recent years, but there is still much room for improvement.
调查河南省县级综合医院重症监护病房（ICU）现状，为提高ICU建设水平及合理配置医疗资源提供依据。
依据国家卫生健康委员会（NHC）印发的《重症医学科建设与管理指南（试行）》（以下简称《指南》），采用自行设计的关于ICU现状的调查问卷，对2018年河南省93家县级综合医院的ICU现状进行横断面调查。调查内容包括ICU基本情况（成立时间、组织管理模式、ICU专科发展、重点学科建设）、规模及人员配备与培训，以及ICU设备及技术发展情况。
ICU现状基本情况如下：其一，成立时间：河南省县级综合医院ICU起步较晚。调查显示，93家医院均已设立ICU，其中最早的是1989年浚县人民医院的ICU，2000年前仅有4家县级综合医院设立ICU，2009年前有34家。其二，管理模式：ICU紧密型管理占比68.82%（64/93），半开放管理占18.28%（17/93），仍采用开放管理模式的医院占12.90%（12/93）。其三，专科ICU发展及重点学科建设：86家医院设立了综合ICU，新生儿ICU、急诊ICU、冠心病监护病房（CCU）等专科ICU占比高于其他专科；8家医院的ICU为河南省卫生健康委重点学科，9家医院的ICU为市级卫生健康委重点学科。ICU规模及人员配备：93家县级综合医院共开放2189张ICU床位。ICU床位使用率达标率及每床ICU床面积达标率较高，分别为76.34%和80.64%，而ICU医生/ICU床位数、ICU护士/ICU床位数达标率较低，分别为8.60%和7.52%，表明临床医生和护理设施不足。本次调查中有1家三级医院、76家二级甲等医院和16家二级乙等医院。二级甲等医院在总床位数（张：922.22±285.99 vs. 636.75±258.84）和ICU床位数（张：25.28±21.15 vs. 14.63±6.89）方面均显著高于二级乙等医院（均P<0.01），二级甲等医院床位使用达标率显著高于二级乙等医院[81.6%（62/76） vs. 50.0%（8/16），P<0.01]。在人员配备方面，初级职称的临床医生和护士占比最高，正高级职称的占比相对较低，本科学历的医生占比最高，专科学历的护士占比最高。在人员培训方面，被调查医院大多派医生和护士参加省级及以上重症医学继续教育培训，分别为745人次和1156人次，每家医院平均分别为8人次和12人次。在ICU设备配置及技术发展方面，县级综合医院ICU设备大多有微量注射泵、监护仪、输液泵、有创呼吸机、排痰机等，但整体设备不足。虽有1家医院引进了体外膜肺氧合（ECMO）设备，但尚未临床开展。河南省县级综合医院均已设立ICU，但多项指标达标率与《指南》要求存在差距，医务人员及设备相对不足。
近年来河南省县级综合医院ICU发展迅速，但仍有很大提升空间。
