Kang Christine, Ryu Ho Geol
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Acute Crit Care. 2023 May;38(2):151-159. doi: 10.4266/acc.2023.00689. Epub 2023 May 31.
The primary aim of this review is to explore current knowledge on the relationship between institutional intensive care unit (ICU) patient volume and patient outcomes. Studies indicate that a higher institutional ICU patient volume is positively correlated with patient survival. Although the exact mechanism underlying this association remains unclear, several studies have proposed that the cumulative experience of physicians and selective referral between institutions may play a role. The overall ICU mortality rate in Korea is relatively high compared to other developed countries. A distinctive aspect of critical care in Korea is the existence of significant disparities in the quality of care and services provided across regions and hospitals. Addressing these disparities and optimizing the management of critically ill patients necessitates thoroughly trained intensivists who are well-versed in the latest clinical practice guidelines. A fully functioning unit with adequate patient throughput is also essential for maintaining consistent and reliable quality of patient care. However, the positive impact of ICU volume on mortality outcomes is also linked to complex organizational factors, such as multidisciplinary rounds, nurse staffing and education, the presence of a clinical pharmacist, care protocols for weaning and sedation, and a culture of teamwork and communication. Despite some inconsistencies in the association between ICU patient volume and patient outcomes, which are thought to arise from differences in healthcare systems, ICU case volume significantly affects patient outcomes and should be taken into account when formulating related healthcare policies.
本综述的主要目的是探究当前关于机构重症监护病房(ICU)患者数量与患者预后之间关系的知识。研究表明,机构ICU患者数量增加与患者生存率呈正相关。尽管这种关联背后的确切机制尚不清楚,但多项研究提出,医生的累积经验以及机构间的选择性转诊可能起到了一定作用。与其他发达国家相比,韩国的ICU总体死亡率相对较高。韩国重症监护的一个显著特点是,不同地区和医院提供的护理质量和服务存在显著差异。解决这些差异并优化危重症患者的管理,需要有经过全面培训、精通最新临床实践指南的重症监护医生。一个具备足够患者流量且运作良好的科室对于维持稳定可靠的患者护理质量也至关重要。然而,ICU患者数量对死亡率结局的积极影响还与复杂的组织因素有关,如多学科查房、护士配备与教育、临床药师的配备、撤机和镇静护理方案以及团队合作与沟通文化等。尽管ICU患者数量与患者预后之间的关联存在一些不一致之处,这些不一致被认为是由医疗系统差异导致的,但ICU病例数量显著影响患者预后,在制定相关医疗政策时应予以考虑。