Impact of reorganization of the Hungarian system of intensive care units in 2012

Abstract

In 2012, the Hungarian system of intensive care units was reorganized. During this process, multidisciplinary units were separated from observation units. The author analysed certain indicators of the remaining intensive care units. The study was based on reports of National Health Insurance Fund between 2000 and 2015. After reorganization the number of the multidisciplinary intensive care units decreased by 20% and the number of beds decreased by 10%. Due to the reorganization, both the case-mix index and the days of mechanical ventilation increased significantly in the multidisciplinary intensive care units. In 2000, 12% of the patients were discharged directly from the intensive care units to home, but by 2014, this figure decreased to 3%. The bed-occupancy rate of the intensive care units did not change fundamentally and it was under 80% in each calendar day. In addition to the ICD leading groups I and J, the rate of "Sine morbo" (U9990) diagnosis decreased from 0.7% to 0.2%. Similarly, the ratio of R group which describes only symptoms decreased from 1.7% to 1.1%. In contrast, between the interventions the number of fluid and electrolyte imbalances and respiratory monitoring showed more than twofold increase. These results suggest that the reorganization was effective. The activity of the intensive care units has improved significantly, without disturbing patient care. The author suggests further analysis on the basis of the same criteria for other departments and the consistent continuation of the reorganization process. Orv. Hetil., 2016, 157(44), 1757-1761.