TY - JOUR
T1 - Effects of ICU characters, human resources and workload to outcome indicators in thai ICUs
T2 - The results of ICU-RESOURCE i study
AU - Chittawatanarat, Kaweesak
AU - Sataworn, Dusit
AU - Thongchai, Chaweewan
AU - Permpikul, Chairat
AU - Chaiwat, Onuma
AU - Kongsayreepong, Suneerat
AU - Vorrakitpokatorn, Puttipunnee
AU - Wilaichone, Warakarn
AU - Bunburaphong, Thananchai
AU - Saengchote, Wanwimol
AU - Morakul, Sunthiti
AU - Thawitsri, Thammasak
AU - Sitthipan, Chanchai
AU - Sombunvibul, Wanna
AU - Chatrkaw, Phornlert
AU - Poonyathawon, Sahadol
AU - Watanathum, Anan
AU - Fuengfoo, Pusit
AU - Sataworn, Dusit
AU - Wongsa, Adisorn
AU - Piyavechviratana, Kunchit
AU - Rungruanghiranya, Suthat
AU - Pothirat, Chaichan
AU - Deesomchok, Attawut
AU - Patjanasoontorn, Boonsong
AU - Bhurayanontachai, Rungsun
AU - Champunut, Ratapum
AU - Chuachamsai, Norawee
AU - Thongchai, Chaweewan
PY - 2014/1
Y1 - 2014/1
N2 - Objective: There was a lack of available data regarding intensive care unit (ICU) characteristics, human resources, workload, and ICU outcomes in Thai ICUs. Therefore, the objectives of the present study were to describe these parameters and to demonstrate the association of these predictors to ICU outcome indicators including crude mortality, ventilator days and ICU length of stay (ICU-LOS). Material and Method: Retrospective survey to 155 participated ICUs across Thailand. ICUs characters, physician and nurse staffing, patient density and ICU outcomes indicator at the year 2011 of monthly mortality, ventilator days and ICU length of stay were recorded. Multilevel mixed effect linear regression was used for cluster analysis. Statistical difference was defined as p-value <0.05. Results: The 132 ICUs (85.16%) were identified as open ICU or low physician staffing. The ICUs were directed or consulted by intensivists or critical care physicians in 53 ICUs and nearly half of them were located in ICUs at academic hospitals. The median value of average daily nurse to patient ratio (NPR) was 0.5 (Inter-quartile range, IQR 0.23). The median crude mortality was 13.92% (IQR 10.16). Median ventilator days and ICU-LOS were 5.31 (IQR 4.42) and 5.8 (IQR 3.0), respectively. A multilevel mixed model demonstrated crude mortality benefit in groups of closed ICU management or high physician staffing, academic ICUs, regular multidisciplinary round, ICU physician staffing availability and low patient density. Although the NPR did not demonstrate any benefit in crude mortality, a lower NPR (higher number of nurse staff) was associated with lower ventilator days. Conclusion: Thai ICUs showed differences in administration systems. The outcome indicators of crude mortality, ventilator days and ICU-LOS were impacted by the ICU characteristics, human resources and ICU workload (Thai Clinical Trial Registry: TCTR-201200005).
AB - Objective: There was a lack of available data regarding intensive care unit (ICU) characteristics, human resources, workload, and ICU outcomes in Thai ICUs. Therefore, the objectives of the present study were to describe these parameters and to demonstrate the association of these predictors to ICU outcome indicators including crude mortality, ventilator days and ICU length of stay (ICU-LOS). Material and Method: Retrospective survey to 155 participated ICUs across Thailand. ICUs characters, physician and nurse staffing, patient density and ICU outcomes indicator at the year 2011 of monthly mortality, ventilator days and ICU length of stay were recorded. Multilevel mixed effect linear regression was used for cluster analysis. Statistical difference was defined as p-value <0.05. Results: The 132 ICUs (85.16%) were identified as open ICU or low physician staffing. The ICUs were directed or consulted by intensivists or critical care physicians in 53 ICUs and nearly half of them were located in ICUs at academic hospitals. The median value of average daily nurse to patient ratio (NPR) was 0.5 (Inter-quartile range, IQR 0.23). The median crude mortality was 13.92% (IQR 10.16). Median ventilator days and ICU-LOS were 5.31 (IQR 4.42) and 5.8 (IQR 3.0), respectively. A multilevel mixed model demonstrated crude mortality benefit in groups of closed ICU management or high physician staffing, academic ICUs, regular multidisciplinary round, ICU physician staffing availability and low patient density. Although the NPR did not demonstrate any benefit in crude mortality, a lower NPR (higher number of nurse staff) was associated with lower ventilator days. Conclusion: Thai ICUs showed differences in administration systems. The outcome indicators of crude mortality, ventilator days and ICU-LOS were impacted by the ICU characteristics, human resources and ICU workload (Thai Clinical Trial Registry: TCTR-201200005).
KW - Closed ICU
KW - Critical care physician
KW - Crude mortality
KW - ICU resources
KW - Intensivist
KW - Nurse to patient ratio
UR - https://www.scopus.com/pages/publications/84902341175
M3 - Article
C2 - 24855839
AN - SCOPUS:84902341175
SN - 0125-2208
VL - 97
SP - S22-S30
JO - Journal of the Medical Association of Thailand
JF - Journal of the Medical Association of Thailand
IS - 1 SUPPL. 1
ER -