| Author | Bastos, Leonardo S. L. | |
| Author | Hamacher, Silvio | |
| Author | Zampieri, Fernando G. | |
| Author | Cavalcanti, Alexandre B. | |
| Author | Salluh, Jorge I. F. | |
| Author | Bozza, Fernando A. | |
| Access date | 2020-07-23T21:19:33Z | |
| Available date | 2020-07-23T21:19:33Z | |
| Document date | 2020 | |
| Citation | BASTOS, Leonardo S. L. et al. Structure and process associated with the efficiency of intensive care units in low-resource settings: An analysis of the CHECKLIST-ICU trial database. Journal of Critical Care, v. 59, p. 118-123, 2020. | |
| ISSN | 0883-9441 | |
| URI | https://www.arca.fiocruz.br/handle/icict/42367 | |
| Language | eng | en_US |
| Publisher | Elsevier | |
| Rights | restricted access | |
| Subject in Portuguese | ICU benchmarking | pt_BR |
| Subject in Portuguese | ICU organization | pt_BR |
| Subject in Portuguese | Intensive care | pt_BR |
| Subject in Portuguese | Organizational characteristics | pt_BR |
| Subject in Portuguese | Quality indicators | pt_BR |
| Title | Structure and process associated with the efficiency of intensive care units in low-resource settings: An analysis of the CHECKLIST-ICU trial database | en_US |
| Type | Preprint | |
| DOI | 10.1016/j.jcrc.2020.06.008 | |
| Abstract | 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. | en_US |
| Affilliation | Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil. | |
| Affilliation | Pontifical Catholic University of Rio de Janeiro. Department of Industrial Engineering. Rio de Janeiro, RJ, Brazil. | |
| Affilliation | Hospital do Coração. Research Institute. São Paulo, SP, Brazil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Brazilian Research in Intensive Care Network. Brazil. | |
| Affilliation | Hospital do Coração. Research Institute. São Paulo, SP, Brazil / Brazilian Research in Intensive Care Network. Brazil. | |
| Affilliation | D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Brazilian Research in Intensive Care Network. Brazil. | |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brasil / Brazilian Research in Intensive Care Network. Brasil. | |
| Embargo date | 2021-07-01 | |
