Heterogeneity in intensive care units: fact or fiction?

Abstract

Reports and guidelines concerning intensive care practice have been issued recently. However, the introduction of such centrally issued recommendations may be difficult because of marked heterogeneity between intensive care units. This study examined the facilities (number of beds, consultant sessions, nursing establishment), annual workload (number and types of patients admitted) and outcome (intensive care unit mortality) in the (old) Anglia Region. There were significant differences in the distribution of patients' ages, severities of illness, diagnoses, durations of admission and outcomes. Such heterogeneity may make multicentre trials more difficult to conduct and create problems when uniform measures designed to improve intensive care services are being planned.

The enhanced postoperative care system

“…They may also be kept in the PACU for extended (N12 hours) periods [5]. The actual components, capabilities, and bed capacities of the enhanced care system are institution-specific [6]. Hospitals may have 1 ICU that cares for both medical and surgical patients, a single surgical ICU, or multiple specialty-specific ICUs, for example, neurosurgical and cardiac surgical units.…”

Effect of centre-, patient- and procedure-related factors on intensive care resource utilisation after cardiac surgery

“…Centre-related differences are as important as patient heterogeneity in explaining variability among centres [2]. Our research suggests that centres that use their resources more efficiently could be identified using our model.…”

Changes in intensive care from 1987 to 1997 – has outcome improved? A single centre study

“…There are obvious differences in ICUs between different continents and countries [25] and between teaching hospitals and non-teaching hospitals [26,27]. Within one region in the UK a surprising heterogeneity in patients' ages, severity of illness, diagnoses, length of stay and ICU mortality was found among eight ICUs [28]. When discussing our findings, it is therefore necessary to ask whether results from one ICU can be compared with other ICUs at all, and especially whether changes over time can be compared.…”