Keenan S P, Doig G S, Martin C M, Inman K J, Sibbald W J
Richard Ivey Critical Care Trauma Center, Victoria Hospital, London, Ontario, Canada.
Intensive Care Med. 1997 May;23(5):574-80. doi: 10.1007/s001340050375.
To determine the ability of the current literature to supply appropriate data for benchmarking admission practice to a multidisciplinary critical care unit.
Retrospective review of data collected prospectively on a cohort of 614 patients and a systematic review of the literature.
A 30-bed multidisciplinary critical care unit at a university teaching hospital.
Consecutive admissions to the critical care unit over a 6-month period.
None.
For each patient, demographic data and admitting diagnosis were recorded on admission. Information necessary to calculate the Acute Physiology and Chronic Health Evaluation II and Therapeutic Intervention Scoring System (TISS) scores were collected daily. TISS variables were categorized as "active" or "non-active" treatment variables. Patients were then identified on a daily basis as receiving or not receiving active treatment. A review of the literature, using MEDLINE and the search term "Therapeutic Intervention Scoring Index" (as a textword), was conducted to identify studies that had similarly divided their patients. Using the method of benchmarking, the proportion of patients admitted who received active treatment during their stay in the critical care units was compared between the index critical care unit and those in the literature. A greater proportion of the patients admitted to our unit received active treatment (97.7%) when compared to other studies in the literature (20-66%). However, a number of potential confounding factors were present, such as the availability of intermediate care units, overnight recovery room ventilation, and critical care bed availability between the index critical care unit and those described in the literature.
The current literature does not provide adequate data on critical care unit admission practices to allow useful application of the method of benchmarking. There is a need for publicly accessible large databases to allow individual critical care units to determine their level of efficiency when compared to similar institutions.
确定现有文献能否提供合适的数据，用于对多学科重症监护病房的收治实践进行基准对比。
对前瞻性收集的614例患者的数据进行回顾性分析，并对文献进行系统回顾。
一所大学教学医院的拥有30张床位的多学科重症监护病房。
6个月期间连续收治入重症监护病房的患者。
无。
记录每名患者入院时的人口统计学数据和入院诊断。每天收集计算急性生理与慢性健康状况评价II（APACHE II）和治疗干预评分系统（TISS）分数所需的信息。TISS变量分为“积极”或“非积极”治疗变量。然后每天确定患者是否接受积极治疗。使用MEDLINE并以“治疗干预评分指数”（作为文本词）为检索词对文献进行回顾，以确定对患者进行类似分组的研究。采用基准对比方法，比较本重症监护病房与文献中其他重症监护病房收治的在重症监护病房住院期间接受积极治疗的患者比例。与文献中的其他研究（20%-66%）相比，我院收治的患者中接受积极治疗的比例更高（97.7%）。然而，存在一些潜在的混杂因素，如中间护理单元的可用性、夜间恢复室通气情况以及本重症监护病房与文献中描述的重症监护病房之间的重症监护床位可用性。
现有文献未提供关于重症监护病房收治实践的充分数据，无法有效应用基准对比方法。需要有公开可及的大型数据库，以便各重症监护病房在与类似机构比较时确定自身的效率水平。
