利用活动指数衡量澳大利亚 ICU 压力对死亡率、非工作时间出院、出院延迟、医院间转院和再入院的影响。
Measuring the Impact of ICU Strain on Mortality, After-Hours Discharge, Discharge Delay, Interhospital Transfer, and Readmission in Australia With the Activity Index.
机构信息
The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Prahran, VIC, Australia.
Department of Intensive Care, Alfred Health, Commercial Road, Prahran, VIC, Australia.
出版信息
Crit Care Med. 2023 Dec 1;51(12):1623-1637. doi: 10.1097/CCM.0000000000005985. Epub 2023 Jul 24.
OBJECTIVES
ICU resource strain leads to adverse patient outcomes. Simple, well-validated measures of ICU strain are lacking. Our objective was to assess whether the "Activity index," an indicator developed during the COVID-19 pandemic, was a valid measure of ICU strain.
DESIGN
Retrospective national registry-based cohort study.
SETTING
One hundred seventy-five public and private hospitals in Australia (June 2020 through March 2022).
SUBJECTS
Two hundred seventy-seven thousand seven hundred thirty-seven adult ICU patients.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Data from the Australian and New Zealand Intensive Care Society Adult Patient Database were matched to the Critical Health Resources Information System. The mean daily Activity index of each ICU (census total of "patients with 1:1 nursing" + "invasive ventilation" + "renal replacement" + "extracorporeal membrane oxygenation" + "active COVID-19," divided by total staffed ICU beds) during the patient's stay in the ICU was calculated. Patients were categorized as being in the ICU during very quiet (Activity index < 0.1), quiet (0.1 to < 0.6), intermediate (0.6 to < 1.1), busy (1.1 to < 1.6), or very busy time-periods (≥ 1.6). The primary outcome was in-hospital mortality. Secondary outcomes included after-hours discharge from the ICU, readmission to the ICU, interhospital transfer to another ICU, and delay in discharge from the ICU. Median Activity index was 0.87 (interquartile range, 0.40-1.24). Nineteen thousand one hundred seventy-seven patients died (6.9%). In-hospital mortality ranged from 2.4% during very quiet to 10.9% during very busy time-periods. After adjusting for confounders, being in an ICU during time-periods with higher Activity indices, was associated with an increased risk of in-hospital mortality (odds ratio [OR], 1.49; 99% CI, 1.38-1.60), after-hours discharge (OR, 1.27; 99% CI, 1.21-1.34), readmission (OR, 1.18; 99% CI, 1.09-1.28), interhospital transfer (OR, 1.92; 99% CI, 1.72-2.15), and less delay in ICU discharge (OR, 0.58; 99% CI, 0.55-0.62): findings consistent with ICU strain.
CONCLUSIONS
The Activity index is a simple and valid measure that identifies ICUs in which increasing strain leads to progressively worse patient outcomes.
目的
重症监护病房（ICU）资源紧张会导致患者预后不良。目前缺乏简单且经过充分验证的 ICU 紧张度评估指标。本研究旨在评估“活动指数”是否是 ICU 紧张度的有效评估指标，该指标是在 COVID-19 大流行期间开发的。
设计
基于全国注册的回顾性队列研究。
地点
澳大利亚 175 家公立和私立医院（2020 年 6 月至 2022 年 3 月）。
对象
27.737 名成年 ICU 患者。
干预措施
无。
测量和主要结果
从澳大利亚和新西兰重症监护学会成人患者数据库中提取的数据与重症监护资源信息系统相匹配。计算每位 ICU 患者（接受 1:1 护理的“患者总数”+“有创通气”+“肾脏替代治疗”+“体外膜氧合”+“活动期 COVID-19”）在 ICU 住院期间的平均日活动指数，除以 ICU 总员工床位数。将患者分为 ICU 非常安静（活动指数＜0.1）、安静（0.1＜0.6）、中等（0.6＜1.1）、繁忙（1.1＜1.6）或非常繁忙（≥1.6）时段。主要结局为院内死亡率。次要结局包括 ICU 非工作时间出院、再次入住 ICU、院内转入另一家 ICU 以及 ICU 出院延迟。中位数活动指数为 0.87（四分位距，0.401.24）。19177 名患者死亡（6.9%）。在非常安静时段，院内死亡率为 2.4%，而在非常繁忙时段则为 10.9%。在调整混杂因素后，处于活动指数较高的 ICU 时段与院内死亡率增加相关（比值比[OR]，1.49；99%置信区间[CI]，1.381.60）、非工作时间出院（OR，1.27；99% CI，1.211.34）、再次入住 ICU（OR，1.18；99% CI，1.091.28）、院内转科（OR，1.92；99% CI，1.722.15）和 ICU 出院延迟减少（OR，0.58；99% CI，0.55~0.62）：这些发现与 ICU 紧张度一致。
结论
活动指数是一种简单有效的评估指标，可以识别 ICU 中压力增加导致患者预后逐渐恶化的情况。
Zotero 插件