Organizational Characteristics, Outcomes, and Resource Use in 78 Brazilian Intensive Care Units: the ORCHESTRA Study

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2015 Oct 27

PMID 26499477

Citations 71

Authors

Marcio Soares

Fernando A Bozza

Derek C Angus

Andre M Japiassu

William N Viana

Roberto Costa

Leonardo Brauer

Bruno F Mazza

Thiago D Correa

Andre L B Nunes

Thiago Lisboa

Fernando Colombari

Alexandre T Maciel

Luciano C P Azevedo

Moyzes Damasceno

Haggeas S Fernandes

Alexandre B Cavalcanti

Pedro E A A do Brasil

Jeremy M Kahn

Jorge I F Salluh

Affiliations

Soon will be listed here.

Abstract

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 medical-surgical (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.

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