Abstract
IntroductionThe aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the ICU with severe sepsis.MethodsA retrospective cohort study was conducted using the database of the Dutch National Intensive Care Evaluation (NICE) registry. Analyses were based on consecutive patients admitted between 1 January 2003 and 30 June 2005 who fulfilled criteria for severe sepsis within the first 24 hours of admission. A 13-item questionnaire was sent to all 32 ICUs across The Netherlands that participated in the NICE registry within this period in order to obtain information on ICU organization and staffing. The association between in-hospital mortality and factors related to ICU organization was investigated using logistic regression analysis, combined with generalized estimation equations to account for potential correlations of outcomes within ICUs. Correction for patient-related factors took place by including Simplified Acute Physiology Score II, age, sex and number of dysfunctioning organ systems in the analyses.ResultsAnalyses based on 4,605 patients from 28 ICUs (questionnaire response rate 90.6%) revealed that a higher annual volume of severe sepsis patients is associated with a lower in-hospital mortality (P = 0.029). The presence of a medium care unit (MCU) as a step-down facility with intermediate care is associated with a higher in-hospital mortality (P = 0.013). For other items regarding ICU organization, no independent significant relationships with in-hospital mortality were found.ConclusionA larger annual volume of patients with severe sepsis admitted to Dutch ICUs is associated with lower in-hospital mortality in this patient group. The presence of a MCU as a step-down facility is associated with greater in-hospital mortality. No other significant associations between in-hospital mortality and factors related to ICU organization were found.
Highlights
The aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the intensive care units (ICUs) with severe sepsis
Analyses based on 4,605 patients from 28 ICUs revealed that a higher annual volume of severe sepsis patients is associated with a lower in-hospital mortality (P = 0.029)
A larger annual volume of patients with severe sepsis admitted to Dutch ICUs is associated with lower inhospital mortality in this patient group
Summary
The aim of the study was to assess the influence of annual volume and factors related to intensive care unit (ICU) organization on in-hospital mortality among patients admitted to the ICU with severe sepsis. During the past decade monitoring the performance of health care providers has become common because of increased awareness of accountability and because of increased attention for optimizing quality of care and patient safety [1]. This trend is seen in medicine in general and in intensive care in particular [2,3]. In order to improve the quality of care, patient outcomes in different ICUs are being registered and subsequently compared, with the aim being to identify aspects at the organizational level that influence patient outcome [4,5]. It is interesting to compare outcomes in this patient group between ICUs and to seek factors at the ICU level that influence outcome
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
