夜間集中治療室からの退院の結果
1Intensive Care National Audit & Research Centre, London, UK.
Lancet (London, England)
|May 3, 2000
まとめ
英国内では,集中治療室 (ICU) からの夜間退院が増加しており,患者さんのアウトカムが悪化している. この傾向は,ベッド不足の可能性を示唆し,リソースの配分を慎重に検討する必要がある.
科学分野:
- クリティカルケア・メディシン
- 医療サービス 研究 医療サービス
- 病院の管理 病院の管理 病院の管理
背景:
- 集中治療室 (ICU) のベッド圧力は,英国で懸念が高まっている.
- 夜の放出は,ICU ベッドプレッシャーを評価するためのプロキシとして使用されました.
- 以前の研究では,夜間放出による影響について詳しく調べられなかった.
研究 の 目的:
- イギリスのICUからの夜間退院の動向を調査する.
- 夜中に退院した患者のアウトカムと昼間のアウトカムを比較する.
- 夜出院,早出院,病院での死亡率との関係を調べる.
主な方法:
- "夜"は"オフィス時間外の時間" (2200-0659 h) と"夜明けの時間" (0000-0459 h) と定義されています.
- 1988-90年 (ICU26人,入院1086人) と1995-98年 (ICU62人,入院21295人) の間の夜間排出率を比較した.
- 夜間および早産の影響を分析し,1995年から1998年までのデータのみを用いた.
主要な成果:
- 夜 (2200-0659時間) に退院したICU生存者の割合は,2.7% (1988-90) から6.0% (1995-98) に増加した.
- 夜 (2200-0659 h) に退院した患者は,病院での最終的な死亡率が高かった (OR 1.46 粗製,1.33 調整).
- 早期出院は夜間 (42.6%対5.0%) でより一般的であり,死亡率 (OR1.35) と著しく関連していました.
結論:
- イギリスのICUからの夜間退院は増加しており,患者のアウトカムが著しく悪化している.
- 夜間の出院は,臨床医によって"早産"とみなされる可能性が高い.
- 夜間排出量の増加は,ICUベッドの容量が不十分であることを示す可能性があり,リソースの割り当てとコスト・ユーティリティの評価が必要です.
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