Volume 5, Issue 2 (6-2021)
EBHPME 2021, 5(2): 90-98 |
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Hosseinpour F, Sedighi M, Hashemi F, Rafiei S. Designing and Evaluating the Establishment of Admission Criteria for Patients in an Intensive Care Unit: A Descriptive Study in Iran. EBHPME 2021; 5 (2) :90-98
URL: http://jebhpme.ssu.ac.ir/article-1-321-en.html
URL: http://jebhpme.ssu.ac.ir/article-1-321-en.html
Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran , sima.rafie@gmail.com
Abstract: (1400 Views)
Background: A few studies have reviewed and revised ICU admission criteria based on specific circumstances and local conditions. The aim was to develop ICU admission criteria and compare the cost, mortality, and length of stay among identified admission priorities.
Methods: This was a cross-sectional study conducted in an intensive care unit of a training hospital in Qazvin, Iran. The study was conducted among 127 patients admitted to ICU from July to September 2019. The data collection tool was a self-designed checklist, which included items regarding patients' clinical data and their billing, type of diagnosis, level of consciousness at the time of hospitalization based on GCS scale or Glasgow Coma Scale, length of stay, and patient status at the time of discharge. Descriptive statistical tests were used to describe study variables, and in order to determine the relationship between study variables, ANOVA and Chi-square test were used.
Results: A set of criteria were designed to prioritize patient admissions in ICU. Based on the defined criteria, patients were categorized into four groups based on patient's stability, hemodynamic, and respiration. Study findings revealed that a significant percentage of patients were admitted to the ward while in the second and third priorities of hospitalization (26.8 % and 32.3 %, respectively). There was a statistically significant difference in the four groups in terms of patients' age, total cost, and insurance share of the total cost (P-value < 0.05).
Conclusion: Study results emphasize the necessity to classify patients based on defined criteria to efficiently use available resources.
Methods: This was a cross-sectional study conducted in an intensive care unit of a training hospital in Qazvin, Iran. The study was conducted among 127 patients admitted to ICU from July to September 2019. The data collection tool was a self-designed checklist, which included items regarding patients' clinical data and their billing, type of diagnosis, level of consciousness at the time of hospitalization based on GCS scale or Glasgow Coma Scale, length of stay, and patient status at the time of discharge. Descriptive statistical tests were used to describe study variables, and in order to determine the relationship between study variables, ANOVA and Chi-square test were used.
Results: A set of criteria were designed to prioritize patient admissions in ICU. Based on the defined criteria, patients were categorized into four groups based on patient's stability, hemodynamic, and respiration. Study findings revealed that a significant percentage of patients were admitted to the ward while in the second and third priorities of hospitalization (26.8 % and 32.3 %, respectively). There was a statistically significant difference in the four groups in terms of patients' age, total cost, and insurance share of the total cost (P-value < 0.05).
Conclusion: Study results emphasize the necessity to classify patients based on defined criteria to efficiently use available resources.
Type of Study: Original article |
Subject:
Healt care Management
Received: 2020/11/4 | Accepted: 2021/06/29 | Published: 2021/06/29
Received: 2020/11/4 | Accepted: 2021/06/29 | Published: 2021/06/29
References
1. 1. Kutzin J, Sparkes SP. Health systems strengthening, universal health coverage, health security and resilience. Bulletin of the World Health Organization. 2016; 94(2): 1. [DOI:10.2471/BLT.15.165050]
2. Heshmati B, Joulaei H. Iran's health-care system in transition. The Lancet. 2016; 387(10013): 29-30. [DOI:10.1016/S0140-6736(15)01297-0]
3. White DB, Braddock CH, Bereknyei S, Curtis JR. Toward shared decision making at the end of life in intensive care units: opportunities for improvement. Arch Intern Med. 2007; 167(5): 461-7. doi: 10.1001/archinte.167.5.461. [DOI:10.1001/archinte.167.5.461]
4. Putignano D, Di Maio FF, Orlando V, De Nicola A, Menditto E. Cost Analysis of an Intensive Care Unit. Journal of Pharmacy and Pharmacology. 2014; 2: 501-7.
5. NIH Consensus Conference. Critical Care Medicine. JAMA. 1983; 2506: 798-804. [DOI:10.1001/jama.250.6.798]
6. Mulley AG. The Allocation of Resources for Medical Intensive Care. In: Presidents Commission for the Study of Ethical Problems in Medicine and Biomedical Research: Securing Access to Health Care. Washington, DC: Government Printing Office. 1983; 3: 285-311.
7. Kollef MH, Shuster DP. Predicting ICU outcomes with scoring systems: underlying concepts and principles. Crit Car Clin. 1994; pp. 101-18.
8. Annez PC, Linn JF. An agenda for research on urbanization in developing countries: a summary of findings from a scoping exercise. Geneva: The World Bank. 2010. PMID: 25506974. [DOI:10.1596/1813-9450-5476]
9. Oostenbrink JB, Buijs-Van der Woude T, van Agthoven M, Koopmanschap MA, Rutten FF. Unit costs of inpatient hospital days. Pharmaco Economics. 2003; 21: 263-71. [DOI:10.2165/00019053-200321040-00004]
10. Harrison DA, Rowan KM. Outcome prediction in critical care: the ICNARC model. Curr Opin Crit Care. 2008; 14(5): 506-12. doi: 10.1097/mcc.0b013e328310165a. [DOI:10.1097/MCC.0b013e328310165a]
11. Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, Bar-Lavi Y, Gurman G, et al. Survival of critically ill patients hospitalized in and out of intensive care under paucity of intensive care unit beds. Crit Care Med. 2004; 32(8): 1654-61. doi: 10.1097/01.CCM.0000133021.22188.35. [DOI:10.1097/01.CCM.0000133021.22188.35]
12. Sinuff T, Kahnamoui K, Cook DJ, Luce JM, Levy MM. Rationing critical care beds: A systematic review. Crit Care Med. 2004; 32: 1588-97. [DOI:10.1097/01.CCM.0000130175.38521.9F]
13. Kraiss LW, Kilberg L, Critch Sh, Johansen H. Short-Stay Carotid Endrterectomy is safe and Cost-Effective. Amer J Surg. 1995; 169(5): 512-5. [DOI:10.1016/S0002-9610(99)80207-4]
14. Task Force of the American College of Critical Care Medicine. Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med. 1999; 27(3): 633-8. [DOI:10.1097/00003246-199903000-00048]
15. Caldeira VMH, Júnior JMS, de Oliveira AM, Rezende S, de Araújo LAG, de Oliveira MR, et al. Criteria for patient admission to an intensive care unit and related mortality rates. Rev Assoc Med Bras. 2010; 56(5): 528-34. [DOI:10.1590/S0104-42302010000500012]
16. Masoudiasl I, Nosratinejad F, Akhavanebehbahani AMM. The proposed model for the integrated structure of health and social welfare system in Iran based on comparative studies. Payesh. 2011; 10(1): 115-25.
17. Bahadori M, Ravangard R, Alimohammadzadeh K. The accreditation of hospitals in Iran. Iranian Journal of Public Health. 2015; 44(2): 295-6.
18. Griner PF. Treatment of Acute Pulmonary Edema: Conventional or Intensive Care. Annals of Internal Medicine. 1972; 77(4): 501-6. [DOI:10.7326/0003-4819-77-4-501]
19. Yazdi Feyzabadi V, Khajeh Z, Radmerikhi S, Mehrolhasani M. The Profile of Health Services Delivery in the Recent Decade of Iran's Health System: An Essential Element in Achieving Universal Health Coverage. Iranian Journal of Epidemiology. 2018; 13(Special Issue): 166-9.
20. Adib-Hajbaghery M, Ahmadishad M. Assessing the time of direct and indirect nursing care in coronary care units and related factors in Shahid Behesti Hospital of Kashan in 2016. J Neyshabur Univ Med Sci. 2018; 6(3): 13-25.
21. Hatam N, Joulaei H, Kazemifar Y, Askarian M. Cost efficiency of the family physician plan in Fars province, southern Iran. Iranian Journal of Medical Sciences. 2012; 37(4): 253-9.
22. Ebrahimipour H, Vafaeina Nouri GA, Esmaeili H, Jamili S. (2015). Studying waiting time of patient during discharge process in clinical departments of Imam Reza hospital affiliated with Mashhad University of Medical Science In 2014. A MSc thesis, Mashhad University of Medical Sciences, Iran.
23. Orgeas-Garrouste M, Montuclard L, Timsit JF, Reignier J, Desmettre T, Karoubi P, et al. Predictors of intensive care unit refusal in French intensive care units: a multiple-center study. Crit Care Med. 2005; 33(4): 750-5. doi: 10.1097/01.ccm.0000157752.26180.f1. [DOI:10.1097/01.CCM.0000157752.26180.F1]
24. Thomas K, Peter JV, Christina J, Jagadish AR, Rajan A, Lionel P, et al. Cost‑utility in medical intensive care patients. Rationalizing ongoing care and timing of discharge from intensive care. Ann Am Thorac Soc. 2015; 12(7): 1058‑65. [DOI:10.1513/AnnalsATS.201411-527OC]
25. Reardon PM, Fernando SM, Van Katwyk S, Thavorn K, Kobewka D, Tanuseputro P, et al. Characteristics, outcomes, and cost patterns of high-cost patients in the intensive care unit. Crit Care Res Pract. 2018; 1-7. [DOI:10.1155/2018/5452683]
26. Aung Y, Nur AM, Ismail A, Aljunid SM. Characteristics and outcome of high-cost ICU patients. Clinico Economics and Outcomes Research. 2019; 11: 505-13. [DOI:10.2147/CEOR.S209108]
27. Kramer AA, Higgins TL, Zimmerman JE. Comparing observed and predicted mortality among ICUs using different prognostic systems: Why do performance assessments differ?. Crit Care Med. 2015; 43(2): 261-9. [DOI:10.1097/CCM.0000000000000694]
28. Ramaraju K, Kaza AM, Balasubramanian N, Chandrasekaran S. Predicting healthcare utilization by patients admitted for COPD exacerbation. J Clin Diagn Res. 2016; 10(2): 13-7. [DOI:10.7860/JCDR/2016/17721.7216]
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