The differences between two selected intensive care units located in central and northern Europe — preliminary observation

Abstract

Background: The aim of this study was to evaluate possible differences in the functioning of two selected intensive care units in Poland and Finland. The activity of the units was analysed over a period of one year. Methods:The following parameters were compared: demography of treated populations, site of admission, category of illness, severity of illness (APACHE-II scale), mean length of stay, demanded workload (TISS-28 scale), mortality (both ICU and hospital) and standardized mortality ratio (SMR). Results:The results of this study indicated that most of the patients in the Polish ICU, regardless of age, diagnosis and APACHE II score, presented significantly longer lengths of stay (14.65 ± 13.6 vs 4.1 ± 4.7 days, P = 0.0001), higher mean TISS-28 score (38.9 ± 9.1 vs 31.2 ± 6.1, P = 0.0001) and higher ICU and hospital mortality (41.5% vs 10.2% and 44.7% vs 21.8%, respectively, P = 0.0001). The values of SMR were 0.9 and 0.85 for the Finnish and Polish ICUs, respectively. Conclusion: The collected data indicate huge differences in the utilisation of critical care resources. Treatment in Polish ICU is concentrated on much more severely ill patients which might be sometimes accompanied by futility of care. In order to verify and correctly interpret the presented phenomena, further studies are needed.

Ocena częstości występowania wewnątrzszpitalnego nagłego zatrzymania krążenia w Polsce

“…Prowadzone między poszczególnymi szpitalami porówny-wanie skuteczności resuscytacji w oparciu o zdefiniowany standaryzowany model prognozowania przeżycia NZK pozwala na obiektywną ocenę postępowania terapeutycznego i poprawę przeżywalności co jest zasadniczym elementem monitorowania jakości leczenia [22]. Obecnie również w Polsce pojawiły się pierwsze głosy nawołujące do potrzeby monitorowania jakości leczenia w obszarze anestezjologii i intensywnej terapii [23,24]. Stworzenie rejestru zarów-no wewnątrz-jak i zewnątrzszpitalnych NZK wpisałoby się w ten kanon.…”

Medical futility treatment in intensive care units

“…On average, those patients spent 13 days in the ICU. For comparison, average duration of ICU stay in Finland is 4 days and in Poland 14 days (2).…”

“…There are different ICUs -general, surgical, infectious diseases, internal medicine, cardiac, gastrointestinal, pediatric, psychiatric, neurological, trauma, etc. If there is an adequate space, equipment and expert health workers, the same level of medical care can be provided on different clinics and departments (2,3). Due to rational care, high costs of treatment and lack of highly qualified medical personnel, smaller hospitals have central ICU where all patients who need mechanical ventilation, cardiovascular support and intensive care are treated (3).…”

“…Although medical futility is a widely known concept, we still do not have a single definition of such procedures (6,10,11). It has been reported previously that different institutions have different approaches to what is considered a medical futility treatment (2).…”

“…The factors associated with differences in the utilization of ICU resources between institutions are the decision-making process about when to start and complete treatment, the patient's condition at the moment of ICU admission, the number of staff employed and the possibility of transferring patients to other organizational units after completed treatment (2). Existing evidence indicates that providing proactive palliative care in the ICU, using either consultative or integrative palliative care interventions, may decrease hospital and ICU length of stay.…”