More skilled clinical management of COVID-19 patients modified mortality in an intermediate respiratory intensive care unit in Italy

Abstract Background Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management. Methods In the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020). Results With improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 days vs. who survived 6.4 ± 3.3 days). T Conclusions The present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.

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The Costs of Caring for Patients in a Tertiary Referral Australian Intensive Care Unit

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300409 ◽

2005 ◽

Vol 33 (4) ◽

pp. 477-482 ◽

Cited By ~ 35

Author(s):

I. J. Rechner ◽

J. Lipman

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Average Length ◽

Cost Driver ◽

Full Time ◽

Tertiary Referral ◽

Agency Staff ◽

Average Length Of Stay ◽

Percentage Difference ◽

Full Time Employment

We determined the direct cost of an Intensive Care Unit (ICU) bed in a tertiary referral Australian ICU and the cost drivers thereof, by retrospectively analysing a number of prospectively designed Hospital- and Unit-specific electronic databases. The study period was a financial year, from 1 July 2002 to 30 June 2003. There were 1615 patients occupying 5692 fractional occupied bed days at a total cost of A$15,915,964, with an average length of stay of 3.69 days (range 0.5–77, median 1.06, interquartile range 2.33). The main cost driver not incorporated into this analysis was blood products (paid for centrally). The average costs of an ICU day and total stay per patient were A$2670 and A$9852 respectively. Staff-related charges were 68.76%, with consumables related expenditure making up 19.65%, clinical support services 9.55% and capital equipment 2.04%. Overtime charges and nursing agency staff were 19.4% of staff-related charges (2.9% for agency staff), 3.9% lower than expenditure associated with full-time employment charges, such as pension and leave. The emergency nature of ICU means it is difficult to accurately set a nursing establishment to cater for all admissions and therefore it is hard to decide what is an acceptable percentage difference between agency/overtime costs compared with the costs associated with full-time staff appointments. Consumable expenditure is likely to increase the most with new innovation and therapies. Using protocol driven practices may tighten and control costs incurred in ICU.

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Respiratory Complications following Tonsillectomy/UPPP: Is Step-Down Monitoring Necessary?

Ear Nose & Throat Journal ◽

10.1177/014556130308200821 ◽

2003 ◽

Vol 82 (8) ◽

pp. 628-632 ◽

Cited By ~ 17

Author(s):

Eric M. Gessler ◽

Peter C. Bondy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Average Length ◽

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Average Length Of Stay ◽

Obstructive Sleep ◽

Respiratory Event ◽

Step Down

We conducted a study to determine if the risk of airway compromise following tonsillectomy with uvulopalatopharyngoplasty justifies the added cost and inconvenience of step-down monitoring in an intensive care unit. We performed a retrospective chart review of 130 patients with obstructive sleep apnea who had undergone isolated tonsillectomy with uvulopalatopharyngoplasty at our tertiary care center. The average length of stay in the step-down unit was 18 hours. We found that only eight of these patients (6.2%) had a postoperative desaturation level of less than 90%, including three of 12 patients (25%) who had comorbid conditions. No patient had an adverse respiratory event. We conclude that step-down monitoring in an intensive care unit is not necessary, although caution should be exercised in monitoring patients with comorbidities because they appear to be more prone to desaturation. A complete lack of adverse respiratory events has not been reported in previous studies.

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Preliminary retrospective analysis of a refeeding program in a psychiatric intensive care unit for patients suffering from extreme severe anorexia nervosa

European Psychiatry ◽

10.1016/s0924-9338(11)72418-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 713-713

Author(s):

C. Born ◽

L. de la Fontaine

Keyword(s):

Intensive Care Unit ◽

Anorexia Nervosa ◽

Intensive Care ◽

Average Length ◽

Care Program ◽

Feeding Tube ◽

Refeeding Syndrome ◽

Average Length Of Stay ◽

Duration Of Illness ◽

Gastric Feeding

IntroductionAnorexia nervosa (AN) is showing the highest mortality in psychiatric illness, especially because of its somatic consequences. A special program for refeeding patients with extreme severe underweight has been established in Munich.MethodsFrom 2000–2010 about 80 patients with any eating disorder were admitted. Data of 53 patients with AN were analysed. After admission most of the patients (n = 43) received a percutaneous gastric feeding tube. A high caloric solution (Fresubin energy) was administered adjusted to bodyweight aiming a weight gain of 700–1000 g per week. After reaching BMI 17 most patients were send for illness specific psychotherapy to a specialized clinic.ResultsThe sample consists of 50 (94.3%) females. Patients were diagnosed as having AN restrictive subtype in 25 cases (47.2%), AN binge/purge subtype in 24 cases (45,2%) and AN purging subtype in 4 cases (7.6%). Mean age at admission was 25.4 years (SD 7.0) and mean duration of illness until admission was 8.4 years (SD 5.7). Average length of stay in the intensive care unit was 135 days (SD 79.4). Mean BMI at admission was 12.3 (SD 1.6) and mean BMI at discharge 16.6 (SD 1.6). Thus, mean weight increase was 11.4 kg (SD 5.4).DiscussionThis intensive care program was established to enable patients with extreme severe AN to participate in psychotherapeutic programs afterwards as it was reported that cognitive function changed in regard to bodyweight. Further evaluation has to consider the occurrence of a refeeding syndrome.

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Implementing Change – the Experience of a District General ICU

Journal of the Intensive Care Society ◽

10.1177/175114370800900306 ◽

2008 ◽

Vol 9 (3) ◽

pp. 224-227

Author(s):

Brian Tehan ◽

Sue O'Keeffe

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Average Length ◽

District General Hospital ◽

Central Line ◽

Line Bundles ◽

Implementing Change ◽

Average Length Of Stay ◽

Significant Difference ◽

Ward Rounds

Patient safety is a major challenge and goal for NHS trusts. This paper describes the experiences of a district general hospital (DGH) intensive care unit (ICU) implementing change methodology under the auspices of the Safer Patients' Initiative (SPI). The team applied small tests of change (PDSA – Plan, Do, Study, Act) and, supported by education and measurement, introduced bundles of care, without the need for significant investment. Ventilator and central line bundles were applied, along with multidisciplinary ward rounds and daily goal sheets. Over a two year period, average length of stay fell from 6 to 2.7 days. The rate of ventilator-acquired pneumonia (VAP) decreased from 24.39 per 1,000 intubated days to 0. As a consequence, there was increased available capacity and admissions increased by one third. At the same time, overall drug costs fell. The application of the change methodology has made a significant difference to the performance of this DGH ICU.

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Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro

Revista de Saúde Pública ◽

10.1590/s1518-8787.2016050005997 ◽

2016 ◽

Vol 50 (0) ◽

Cited By ~ 8

Author(s):

Rosane Sonia Goldwasser ◽

Maria Stella de Castro Lobo ◽

Edilson Fernandes de Arruda ◽

Simone Aldrey Angelo ◽

José Roberto Lapa e Silva ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Rio De Janeiro ◽

Average Length ◽

Patient Flow ◽

The State ◽

System Stability ◽

Ministry Of Health ◽

Average Length Of Stay

ABSTRACT OBJECTIVE To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health. METHODS The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011. RESULTS There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours. CONCLUSIONS Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.

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Factors Affecting the Length of Stay in the Intensive Care Unit: Our Clinical Experience

BioMed Research International ◽

10.1155/2018/9438046 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Mehmet Toptas ◽

Nilay Sengul Samanci ◽

İbrahim Akkoc ◽

Esma Yucetas ◽

Egemen Cebeci ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Average Length ◽

Cerebrovascular Diseases ◽

Factors Affecting ◽

Average Length Of Stay ◽

Lengths Of Stay ◽

Life Threatening ◽

Hospital Days

Background and Aim. Long hospital days in intensive care unit (ICU) due to life-threatening diseases are increasing in the world. The primary goal in ICU is to decrease length of stay in order to improve the quality of medical care and reduce cost. The aim of our study is to identify and categorize the factors associated with prolonged stays in ICU.Materials and Method. We retrospectively analyzed 3925 patients. We obtained the patients’ demographic, clinical, diagnostic, and physiologic variables; mortality; lengths of stay by examining the intensive care unit database records.Results. The mean age of the study was 61.6 ± 18.9 years. The average length of stay in intensive care unit was 10.2 ± 25.2 days. The most common cause of hospitalization was because of multiple diseases (19.5%). The length of stay was positively correlated with urea, creatinine, and sodium. It was negatively correlated with uric acid and hematocrit levels. Length of stay was significantly higher in patients not operated on than in patients operated on (p<0.001).Conclusion. Our study showed a significantly increased length of stay in patients with cardiovascular system diseases, multiple diseases, nervous system diseases, and cerebrovascular diseases. Moreover we showed that when urea, creatinine, and sodium values increase, in parallel the length of stay increases.

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