Prospective assessment of standardized mortality ratio (SMR) as a measure of quality of care in intensive care unit--a single-centre study.

BACKGROUND: The standardized mortality ratio (SMR) is a recognized indicator of critical care quality. This ratio is used to compare actual hospital mortality of all patients treated in a Intensive Care Unit (ICU) with predicted mortality. The aim of the study was prospective analysis of SMR as a measure of quality of care in single ICU. METHOD: Prospective study was performed during the period of 12 months in ICU of Czerniakowski Hospital in Warsaw. Predicted hospital mortality was calculated using the SAPS 3 model. The value of SMR was evaluated in the three risk groups (low, moderate, high risk) and included patients surgical status (nonoperative, after elective and emergency surgery). RESULTS: A total of 341 patients were included. SMR in general population was 0,98 (95% CI 0,74-1,28). In the low and high-risk groups the value of SMR did not differ significantly from 1. In the average risk group as well as patients undergoing elective surgery, the value of SMR tended to exceed 1. CONCLUSIONS: In groups of patients with low and high risk the values of SMR indicated favourable quality of care. Study results should prompt to carry out detailed analysis of the course of treatment of patients at average risk of death. Analysis of the course of treatment and qualification criteria for surgery in patients undergoing elective surgery is also indicated.

[Epidemiology of infections at the intensive care unit]. / Epidemiologia zakazen w oddziale intensywnej terapii.

OBJECTIVES: Infections at the Intensive Care Units (ICU) are a substantial clinical problem due to their high incidence and significant impact on patient mortality, as well as on the duration of their treatment within ICUs. The objective of the present study was to analyse the infections occurring at our department and to identify those micro-organisms responsible for infections, with consideration of their susceptibility to antibiotic treatment. Moreover, an evaluation was performed in respect of correlation between infection incidence, patient mortality and duration of stay at the department. MATERIAL AND METHODS: The study concerned all patients admitted to the ICU between February and July 2004, with a stay duration of > 24h. The occurring infections were divided into groups, depending on the first symptoms occurrence, of external infections (< 48h) and intra-department infections (> 48h). When diagnosing infection symptoms, the CDC definitions were applied. RESULTS: 78 patients were qualified to participate in the study, among which external infections were diagnosed in 73%, while infections at the department were diagnosed in 44.9%. The average APACHE II scale scoring in the first day of treatment was 20, higher in the case of external infections. The most commonly occurring infections were: pneumonia (33%), blood infections (17%), lower respiratory tract infections (15%) and urinary tract infections (12%). The most commonly cultured micro-organisms responsible for observed infections were: Candida sp., Enterococcus sp., Staphylococcus sp., Pseudomonas sp., Enterobacter sp. and Acinetobacter sp. Among studies patients, the death rate was 37%. High mortality correlated with old age, higher APACHE II scoring and presence of externally acquired infections. The average stay at the department was 10 days and was significantly longer than in patients with department infections. CONCLUSIONS: The distribution of infections and their etiological pathogens was similar to results obtained in studies performed in other developed countries. A correlation was evidenced between the occurrence of external, internal infections and, respectively, the increased mortality and length of hospitalisation of patients within ICUs.