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Structure and process associated with the efficiency of intensive care units in low-resource settings: An analysis of
Leonardo S L Bastos1, Silvio Hamacher1, Fernando G Zampieri2
1Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil.
Insights
Efficient intensive care units (ICUs) in low-resource settings utilize active surveillance for infections and invasive devices. These practices are key to improving ICU performance and patient outcomes.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Infectious Disease Epidemiology
Background:
- Organizational factors significantly influence intensive care unit (ICU) performance and patient outcomes.
- Identifying characteristics of efficient ICUs is crucial, especially in resource-limited environments.
Purpose of the Study:
- To identify organizational characteristics linked to efficient ICUs in low-resource settings.
- To understand how structure and process impact ICU efficiency and patient outcomes.
Main Methods:
- Secondary analysis of the multicenter cluster-randomized CHECKLIST-ICU trial in Brazil.
- ICUs classified as efficient if standardized mortality ratio (SMR) and standardized resource use (SRU) were below median.
- Regularized logistic regression used to assess associations between organizational factors and efficiency.
Main Results:
- Of 118 ICUs, 47 were efficient and 71 non-efficient.
- Efficient ICUs showed lower rates of central line-associated bloodstream infections, mechanical ventilation, central venous catheter, and indwelling urinary catheter utilization.
- Active surveillance of ventilator-associated pneumonia and central venous catheter utilization were associated with ICU efficiency.
Conclusions:
- Active surveillance of nosocomial infections and judicious use of invasive devices are associated with ICU efficiency in low-resource settings.
- Performance indicators and management strategies are vital for improving ICU operations and patient care.
Purpose:
Characteristics of structure and process impact ICU performance and the outcomes of critically ill patients. We sought to identify organizational characteristics associated with efficient ICUs in low-resource settings.
Materials And Methods:
This is a secondary analysis of a multicenter cluster-randomized clinical trial in Brazil (CHECKLIST-ICU). Efficient units were defined by standardized mortality ratio (SMR) and standardized resource use (SRU) lower than the overall medians and non-efficient otherwise. We used a regularized logistic regression model to evaluate associations between organizational factors and efficiency.
Results:
From 118 ICUs (13,635 patients), 47 units were considered efficient and 71 non-efficient. Efficient units presented lower incidence rates (median[IQR]) of central line-associated bloodstream infections (4.95[0.00-22.0] vs 6.29[0.00-25.6], p = .04), utilization rates of mechanical ventilation (0.41[0.07-0.73] vs 0.58[0.19-0.82], p < .001), central venous catheter (0.67[0.15-0.98] vs 0.78[0.33-0.98], p = .04), and indwelling urinary catheter (0.62[0.22-0.95] vs 0.76[0.32-0.98], p < .01) than non-efficient units. The reported active surveillance of ventilator-associated pneumonia (OR = 1.72; 95%CI, 1.16-2.57) and utilization of central venous catheters (OR = 1.94; 95%CI, 1.32-2.94) were associated with efficient ICUs.
Conclusions:
In low-resource settings, active surveillance of nosocomial infections and the utilization of invasive devices were associated with efficiency, supporting the management and evaluation of performance indicators as a starting point for improvement in ICU.
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