Moreno R, Reis Miranda D
Intensive Care Unit, Hospital de Santo António dos Capuchos, Lisbon, Portugal.
Chest. 1998 Mar;113(3):752-8. doi: 10.1378/chest.113.3.752.
To test the use of a human resources-based classification of levels of care of ICUs; to evaluate the match between planned vs operative levels of care on a large sample of European ICUs.
Analysis of the database of a multicentric, multinational, prospective cohort study, involving 89 ICUs from 13 European areas.
Database of EURICUS-I.
Provision of resources was measured as the number of nurses per ICU bed. Use of resources was measured by the daily use of a therapeutic index (nine equivalents of nursing manpower use score, NEMS) at patient level. Work utilization ratio (WUR) indicated the total number of NEMS points actually scored divided by the total possible NEMS score on each ICU. The planned level of care (LOC) or the mean number of patients to be assisted by one nurse (P/N ratio) made available to the unit was derived from the number of nurses and the number of beds in the ICU. The operative LOC or the actual mean number of patients who were assisted by one nurse (P/N ratio) was computed by dividing the number of NEMS points equivalent to the work of three nursing-shifts (46 points) by the mean daily NEMS score at ICU level. Severity of illness was evaluated by the new simplified acute physiology score. Kappa statistics, intraclass correlation coefficients, and interrater percentage of agreement were used to evaluate the reliability of the data collected for total NEMS score. Chi2 statistics and one-way analysis of variance were used when appropriate.
Data of 16,047 patients (74,383 patient-days) admitted to the ICUs were analyzed. With an overall value of 26.5+/-9.3, the mean NEMS score at ICU level varied significantly among European areas. These differences were not explained by the severity of illness of the patients. The mean WUR was 0.73+/-0.29, presenting also significant differences among ICUs and European areas that were not explained by severity of illness. There was a mismatch between planned vs operative LOCs on 68 ICUs (76%); on 65 (73%), the operative LOC was lower than the planned LOC. This loss of resources concerned particularly the 61 ICUs planned to operate at LOC 3.
The use of human resources-based classification of LOCs is an objective method for evaluation of the match between provision and use of resources in the ICU. This study has shown a large mismatch between planned and utilized LOC in a sample of 89 European ICUs. This mismatch, suggesting an important loss of invested resources, was more apparent in the ICUs that were planned to operate at a higher level of care.
测试基于人力资源的重症监护病房（ICU）护理级别分类的应用；评估大量欧洲ICU中计划护理级别与实际护理级别之间的匹配度。
对一项多中心、跨国、前瞻性队列研究的数据库进行分析，该研究涉及来自欧洲13个地区的89个ICU。
EURICUS-I数据库。
资源提供量以每个ICU床位的护士数量来衡量。资源使用量通过在患者层面每日使用治疗指数（九个护理人力使用评分当量，NEMS）来衡量。工作利用率（WUR）表示每个ICU实际获得的NEMS总分除以可能获得的NEMS总分。计划护理级别（LOC）或单位可提供的一名护士平均护理患者数量（P/N比）由ICU的护士数量和床位数得出。实际护理级别或一名护士实际护理的平均患者数量（P/N比）通过将相当于三个护理班次工作量的NEMS分数（46分）除以ICU层面的每日平均NEMS分数来计算。疾病严重程度通过新的简化急性生理学评分来评估。使用Kappa统计量、组内相关系数和评分者间一致率百分比来评估收集的总NEMS分数数据的可靠性。适当情况下使用卡方统计量和单因素方差分析。
分析了16047例入住ICU患者（74383个患者日）的数据。ICU层面的平均NEMS评分为26.5±9.3，在欧洲各地区之间差异显著。这些差异无法用患者的疾病严重程度来解释。平均WUR为0.73±0.29，在ICU和欧洲各地区之间也存在显著差异，且无法用疾病严重程度来解释。68个ICU（76%）的计划护理级别与实际护理级别不匹配；65个（73%）的实际护理级别低于计划护理级别。资源损失尤其涉及计划在护理级别3运行的61个ICU。
基于人力资源的护理级别分类应用是评估ICU资源提供与使用之间匹配度的一种客观方法。本研究表明，在89个欧洲ICU样本中，计划护理级别与实际使用的护理级别存在很大不匹配。这种不匹配表明投入资源的重大损失，在计划以更高护理级别运行的ICU中更为明显。
