engleski

Croatian survey on intensive care units

Introduction. The aim of the study was to form the Register of intensive care units (ICUs) in Croatia and to examine their present organizational and medical practices associated with outcome performances. Methods. Demographic, hospital, ICU structure and organization, patient demographic, disposable equipment, admission, discharge and outcome data were collected by census questionnaires and analysed. Results. There were 123 ICUs in Croatia, we received 117 voluntary responses (95.1%) to our census questionnaire. There were 900 ICUs beds, 3.33% of all hospital beds. ICUs were divided into 13 subtypes: 27 (23%) surgical, 18 (15.4%) mixed (surgical&medical), 15 (12.8%) mixed (coronary care&medical), 14 (12.8%) coronary care, 10 (8.5%) neurologic, 9 (7.7%) medical, 7 (6.0%) neonatal, 6 (5.1%) psychiatric, 4 (3.4%) respiratory, 3 (2.6%) pediatric, 2 (1.7%) trauma, 1 (0.9%) burns and 1 (0.9%) ICU for infective diseases. 13 (11.1%) ICUs were free-standing, 88.9% were within hospitals departments of various subspecialities.The number of ICUs per hospital increased with the overall hospital size. As hospital size increased, mixed units diminish and specialization of units became prevalent. The number of ICUs beds, the quantity of disposable equipment, permanently employed staff within hospitals and individual units increased as the hospital size increased, it was higher in teaching hospitals and increased with the subspeciality of ICU. Admission from other hospitals represented a significantly larger group of patients in three pediatric units (83.4%) and ICU for infective diseases (40%) in teaching hospitals, which was a sign of their subspeciality. The mean bed occupancy rate was 85.2%, medical, surgical, mixed and coronary care units had mean length of stay 3-4 days, compared to neurological, neonatal, pediatric, respiratory, burns, trauma and infective disease ICUs, which had a mean length of stay of more than 7 days. ICU mortality rate was the lowest in psychiatrical units (3.1%) and the highest in ICU for infective diseases (30%), followed by neurological (18.8%), medical (16.7%) and respiratory (16.5%) units. Conclusion. This report should be viewed as the initial step in the effort to improve both the information base available on intensive care medicine and the performance of ICUs. Our survey findings provide an introduction into the everyday workings of ICUs throughout Croatia. While there are similarities between Croatian ICUs, large differences still remain, esspecially between teaching and nonteaching hospitals. It is important to identify our needs, problems and posibilities. CSICM's next step should be a prospective multicenter study with periodical questionnaires on ICUs structure and organization, on-site organizational analysis, interviews and direct observations by a team of clinical and organizational researchers, patients and their families. References. 1. Zimmerman JE, Shortell SM, Rousseau DM, Duffy J, Gillies RR, Knaus WA et al. Crit Care Med 1993 ; 21:1443-51. 2. Ridley SA, Morgan GA. Lancet 2000 ; 355:1997-8. 3. Ferdinande P, Members of the Task Force of the European Society of Intensive Care Medicine. Intensive Care Med 1997 ; 23:226-32. 4. Goldfrad C, Rowan K. Lancet 2000 ; 355:1138-42.

national data base; survey; intensive care units; performance

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