Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study
| Autor(a) principal: | |
|---|---|
| Data de Publicação: | 2015 |
| Outros Autores: | , , , , , , , , , , , , , , , , , , |
| Tipo de documento: | Artigo |
| Idioma: | eng |
| Título da fonte: | Repositório Institucional da FIOCRUZ (ARCA) |
| Texto Completo: | https://www.arca.fiocruz.br/handle/icict/34875 |
Resumo: | 2020-08-19 |
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Soares, MarcioBozza, Fernando A.Angus, Derek C.Japiassú, André M.Viana, William N.Costa, RobertoBrauer, LeonardoMazza, Bruno F.Corrêa, Thiago D.Nunes, André L. B.Lisboa, ThiagoColombari, FernandoMaciel, Alexandre T.Azevedo, Luciano C. P.Damasceno, MoyzésFernandes, Haggeas S.Cavalcanti, Alexandre B.Brasil, Pedro E. A. A. doKahn, Jeremy M.Salluh, Jorge I. F.2019-08-19T14:57:40Z2019-08-19T14:57:40Z2015SOARES, Marcio et al. Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Medicine, v. 41, p. 2149-2160, 2015.0342-4642https://www.arca.fiocruz.br/handle/icict/3487510.1007/s00134-015-4076-71432-1238engSpringerOrganizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA studyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article2020-08-19D’Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.D’Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.University of Pittsburgh. School of Medicine. Department of Critical Care Medicine. Pittsburgh, PA, USA.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Rede Amil de Hospitais. Department of Critical Care. Rio de Janeiro, RJ, Brazil.Hospital Copa D’Or. ICU. Rio de Janeiro, RJ, Brazil.Hospital Quinta D’Or. ICU. Rio de Janeiro, RJ, Brazil.Hospital São Luiz - Unidade Itaim. São Paulo, SP, Brasil / Imed Group. Department of Critical Care. São Paulo, SP, Brazil.Hospital São Luiz - Unidade Morumbi. São Paulo, SP, BrasilHospital Israelita Albert Einstein. ICU. São Paulo, SP, Brazil.Hospital São Luiz - Unidade Anália Franco. São Paulo, SP, Brasil.Santa Casa de Misericórdia de Porto Alegre. Complexo Hospitalar. Porto Alegre, RS, Brasil.Hospital Alemão Oswaldo Cruz. ICU. São Paulo, SP, Brazil.Hospital São Camilo - Pompeia. ICU. São Paulo, SP, Brazil.Hospital Sírio-Libanês. ICU. São Paulo, SP, Brazil.Complexo Hospitalar de Niterói. ICU. Niterói, RJ, Brazil.Hospital São Luiz - Unidade Brasil. Santo André, SP, Brasil.Hospital do Coração. Hospital do Coração. São Paulo, SP, Brazil.Hospital Copa D’Or. ICU. Rio de Janeiro, RJ, Brazil.University of Pittsburgh. Graduate School of Public Health. Department of Health Policy and Management. Pittsburgh, PA, USA.Hospital Copa D’Or. ICU. Rio de Janeiro, RJ, Brazil.Purpose: Detailed information on organization and process of care in intensive care units (ICU) in emerging countries is scarce. Here, we investigated the impact of organizational factors on the outcomes and resource use in a large sample of Brazilian ICUs. Methods: Retrospective cohort study of 59,693 patients (medical admissions, 67 %) admitted to 78 ICUs during 2013. We retrieved patients’ data from an ICU quality registry and surveyed ICUs regarding structure, organization, staffing patterns, and process of care. We used multilevel logistic regression analysis to identify factors associated with hospital mortality. Efficient resource use was assessed by estimating standardized resource use and mortality rates adjusted for the SAPS 3 score. Results: ICUs were mostly medicalsurgical (79 %) and located at private hospitals (86 %). Median nurse to bed ratio was 0.20 (IQR, 0.15–0.28) and board-certified intensivists were present 24/7 in 16 (21 %) of ICUs. Multidisciplinary rounds occurred in 67 (86 %) and daily checklists were used in 36 (46 %) ICUs. Most frequent protocols focused on sepsis management and prevention of healthcare-associated infections. Hospital mortality was 14.4 %. In multivariable analysis, the number of protocols was the only organizational characteristic associated with mortality [odds ratio = 0.944 (95 % CI 0.904–0.987)]. The effects of protocols were consistent across subgroups including surgical and medical patients as well as the SAPS 3 tertiles. We also observed a significant trend toward efficient resource use as the number of protocols increased. Conclusions: In emerging countries such as Brazil, organizational factors, including the implementation of protocols, are potential targets to improve patient outcomes and resource use in ICUs.Organizational factorsOutcomesStandardized resource useIntensive care unitProtocolsinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83104https://www.arca.fiocruz.br/bitstream/icict/34875/1/license.txt79178e5f2a0eb066867a274556814938MD51ORIGINALve_Soares_Marcio_etal_INI_2015.pdfve_Soares_Marcio_etal_INI_2015.pdfapplication/pdf945878https://www.arca.fiocruz.br/bitstream/icict/34875/2/ve_Soares_Marcio_etal_INI_2015.pdf1559276d05c3d172b4b5def287c71002MD52TEXTve_Soares_Marcio_etal_INI_2015.pdf.txtve_Soares_Marcio_etal_INI_2015.pdf.txtExtracted 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| dc.title.pt_BR.fl_str_mv |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study |
| title |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study |
| spellingShingle |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study Soares, Marcio Organizational factors Outcomes Standardized resource use Intensive care unit Protocols |
| title_short |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study |
| title_full |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study |
| title_fullStr |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study |
| title_full_unstemmed |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study |
| title_sort |
Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study |
| author |
Soares, Marcio |
| author_facet |
Soares, Marcio Bozza, Fernando A. Angus, Derek C. Japiassú, André M. Viana, William N. Costa, Roberto Brauer, Leonardo Mazza, Bruno F. Corrêa, Thiago D. Nunes, André L. B. Lisboa, Thiago Colombari, Fernando Maciel, Alexandre T. Azevedo, Luciano C. P. Damasceno, Moyzés Fernandes, Haggeas S. Cavalcanti, Alexandre B. Brasil, Pedro E. A. A. do Kahn, Jeremy M. Salluh, Jorge I. F. |
| author_role |
author |
| author2 |
Bozza, Fernando A. Angus, Derek C. Japiassú, André M. Viana, William N. Costa, Roberto Brauer, Leonardo Mazza, Bruno F. Corrêa, Thiago D. Nunes, André L. B. Lisboa, Thiago Colombari, Fernando Maciel, Alexandre T. Azevedo, Luciano C. P. Damasceno, Moyzés Fernandes, Haggeas S. Cavalcanti, Alexandre B. Brasil, Pedro E. A. A. do Kahn, Jeremy M. Salluh, Jorge I. F. |
| author2_role |
author author author author author author author author author author author author author author author author author author author |
| dc.contributor.author.fl_str_mv |
Soares, Marcio Bozza, Fernando A. Angus, Derek C. Japiassú, André M. Viana, William N. Costa, Roberto Brauer, Leonardo Mazza, Bruno F. Corrêa, Thiago D. Nunes, André L. B. Lisboa, Thiago Colombari, Fernando Maciel, Alexandre T. Azevedo, Luciano C. P. Damasceno, Moyzés Fernandes, Haggeas S. Cavalcanti, Alexandre B. Brasil, Pedro E. A. A. do Kahn, Jeremy M. Salluh, Jorge I. F. |
| dc.subject.en.pt_BR.fl_str_mv |
Organizational factors Outcomes Standardized resource use Intensive care unit Protocols |
| topic |
Organizational factors Outcomes Standardized resource use Intensive care unit Protocols |
| description |
2020-08-19 |
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2015 |
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2015 |
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2019-08-19T14:57:40Z |
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2019-08-19T14:57:40Z |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
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SOARES, Marcio et al. Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Medicine, v. 41, p. 2149-2160, 2015. |
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https://www.arca.fiocruz.br/handle/icict/34875 |
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0342-4642 |
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10.1007/s00134-015-4076-7 |
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1432-1238 |
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SOARES, Marcio et al. Organizational characteristics, outcomes, and resource use in 78 Brazilian intensive care units: the ORCHESTRA study. Intensive Care Medicine, v. 41, p. 2149-2160, 2015. 0342-4642 10.1007/s00134-015-4076-7 1432-1238 |
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Springer |
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Springer |
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