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首页> 美国卫生研究院文献>American Journal of Respiratory and Critical Care Medicine >The Impact of the Organization of High-Dependency Care on Acute Hospital Mortality and Patient Flow for Critically Ill Patients
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The Impact of the Organization of High-Dependency Care on Acute Hospital Mortality and Patient Flow for Critically Ill Patients

机译：高危护理组织对重症患者急性医院死亡率和患者流量的影响

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>Rationale: Little is known about the utility of provision of high-dependency care (HDC) that is in a geographically separate location from a primary intensive care unit (ICU).>Objectives: To determine whether the availability of HDC in a geographically separate unit affects patient flow or mortality for critically ill patients.>Methods: Admissions to ICUs in the United Kingdom, from 2009 to 2011, who received Level 3 intensive care in the first 24 hours after admission and subsequently Level 2 HDC. We compared differences in patient flow and outcomes for patients treated in hospitals providing some HDC in a geographically separate unit (dual HDC) with patients treated in hospitals providing all HDC in the same unit as intensive care (integrated HDC) using multilevel mixed effects models.>Measurements and Main Results: In 192 adult general ICUs, 21.4% provided dual HDC. Acute hospital mortality was no different for patients cared for in ICUs with dual HDC versus those with integrated HDC (adjusted odds ratio, 0.94 [0.86–1.03]; P = 0.16). Dual HDC was associated with a decreased likelihood of a delayed discharge from the primary unit. However, total duration of critical care and the likelihood of discharge from the primary unit at night were increased with dual HDC.>Conclusions: Availability of HDC in a geographically separate unit does not impact acute hospital mortality. The potential benefit of decreasing delays in discharge should be weighed against the increased total duration of critical care and greater likelihood of a transfer out of the primary unit at night.
机译：>理论上：人们对提供高依赖性护理（HDC）的效用知之甚少，这种护理位于与初级重症监护病房（ICU）地理位置不同的位置。>目标：确定在不同地理位置的病房中是否存在HDC是否会影响重症患者的患者流量或病死率。>方法： 2009年至2011年英国重症监护病房（ICU）入院，接受3级重症监护入院后的头24小时内进行护理，然后进行2级HDC。我们使用多级混合效应模型，比较了在地理上分开的单位（双HDC）中提供一些HDC的医院治疗的患者与在重症监护室（综合HDC）在同一单元中提供所有HDC的医院治疗的患者的流量和结局的差异。 >测量和主要结果：在192个成人普通ICU中，有21.4％提供了双重HDC。双重HDC与合并HDC的ICU护理患者的急性医院死亡率无差异（校正后的优势比为0.94 [0.86-1.03]； P = 0.16）。双重HDC与初级设备延迟放电的可能性降低有关。但是，双重HDC可以增加重症监护的总时间和夜间从基层出院的可能性。>结论：在地理上分开的部门中使用HDC不会影响急性医院死亡率。应权衡减少出院延误的潜在好处与增加的重症监护总时间和夜间转移出主要病房的更大可能性。

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