Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers.

OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

Determining nurses' perceptions of patient safety culture in palliative care centres.

Background: Palliative care patients often do not have decision-making capacity at the end of life so this patient group is vulnerable to violations of patient safety.Aim: To determine the attitudes of nurses in palliative care centres in Turkey towards the patient safety culture and to identify factors affecting these.Method: A descriptive, cross-sectional design using self-report questionnaires was used.Results: The mean Patient Safety Culture Scale points of the whole group were 2.91 ± 0.44. In the sub-dimensions of the scale, the highest points were determined in Employee Training (2.99 ± 0.51) and the lowest in Unexpected Events and Error Reporting (2.81 ± 0.54).Conclusions: Patient safety culture is related to nurses' working conditions and the attitude of management towards errors, etc. The results of this study will provide a contribution to the development of healthcare and healthcare training policies for critical units vulnerable to patient safety violations.

A retrospective study examining the properties and characteristics of dementia patients in a palliative care center

Background/aim: The aim of this study is to evaluate why dementia patients (DPs) are admitted to a palliative care center (PCC) and which factors affect the length of stay (LOS) of DPs in the PCC, and to predict the course of the disease. Materials and methods: The files of DPs were scanned retrospectively in the PCC between 2013 and 2016. Data related to age, sex, LOS, symptoms, clinical conditions, comorbidities, and prognosis were recorded. Results: The study included 85 DPs with a mean age of 84.1 ± 6.7 years. LOS was determined as a median of 15.0 days. While LOS decreased due to age and cancer, it increased due to pressure injury. Although mortality was increased by LOS, it was decreased by hypertension, mobilization, and percutaneous endoscopic gastrostomy. Among the DPs who were admitted to the PCC, the death rate was 54.1% and the discharge rate was 45.9%. Conclusion: It is concluded that adopting a palliative care approach eases symptom management. While this approach decreases the burden of symptoms, it at the same time increases the quality of life of DPs and their families.

An Examination of Factors Affecting the Length of Stay in a Palliative Care Center.

BACKGROUND: With the increase in elderly population, life-threatening chronic diseases are increasing, simultaneously increasing the need for palliative care centers (PCCs). OBJECTIVES: To evaluate the factors affecting the length of stay (LOS) and discharge of patients from a PCC. METHODS: A retrospective scan was made of the records of patients followed up in the PCC between January 2013 and March 2016. A record was made of patient age, gender, diagnosis, conditions/comorbidities, Glasgow Coma Scale, Karnofsky Performance Scale, LOS, prognosis (exitus or surviving), percutaneous endoscopic gastrostomy (PEG), tracheostomy, mechanical ventilator, nutrition (total parenteral nutrition [TPN] or enteral nutrition), and the results of cultures taken during stay in PCCs (blood, tracheal aspirate, urine, rectal swab, wound). Evaluation with regression analysis was made of the data related to factors thought to have a possible effect on the LOS in PCCs. RESULTS: Four hundred thirty-five patients were included in the study, comprising 58.6% men and 41.4% women with a mean age of 70.6 ± 17.2 years. The LOS was 27.2 ± 30.9 days. A total of 234 patients were discharged and 201 (46.2%) were lost to mortality in PCCs. The bacteria most isolated in cultures were Escherichia coli (28.5%) and methicillin resistant Staphylococcus aureus (MRSA) (17%). According to the results of the regression analysis, cancer, hypoxic brain, and advanced age had a negative effect on LOS and PEG, TPN, hypertension, and E. coli, Proteus, Pseudomonas, and Acinetobacter infections increased LOS. CONCLUSION: The results of this study revealed some basic factors that affect LOS in PCCs. However, there may be much variation in the data obtained with the various reasons for which this patient group is admitted to a PCC.

Long-term care hospitals in Turkey: a review.

A long-term care hospital (LTCH) is a specialized facility for patients with serious health problems who require continuous and intensive care but not comprehensive diagnostic methods. LTCHs provide prolonged complex care and wound care in the period following the acute stage of disease. When intensive care unit (ICU) stay is prolonged in the United States of America, the patients may be transferred to an LTCH. Medicare suggests hospitalization > 25 days in LTCHs. The LTC system in Europe differs from that in other non-European countries and differences are also seen among European countries. In practice, patients who need LTC in Turkey are hospitalized in ICUs. Long term care is a new concept for the Turkish health system and there are no studies on LTCHs in Turkey. A significant proportion of intensive care beds in Turkey are used for long-term hospitalized patients with complex problems. This is a clear waste of resources. The establishment of LTCHs in Turkey would prevent from this waste and provide the opportunity to increase experience of complex treatments.

Traumatic brain injury and palliative care: a retrospective analysis of 49 patients receiving palliative care during 2013-2016 in Turkey.

Traumatic brain injury (TBI), which is seen more in young adults, affects both patients and their families. The need for palliative care in TBI and the limits of the care requirement are not clear. The aim of this study was to investigate the length of stay in the palliative care center (PCC), Turkey, the status of patients at discharge, and the need for palliative care in patients with TBI. The medical records of 49 patients with TBI receiving palliative care in PCC during 2013-2016 were retrospectively collected, including age and gender of patients, the length of stay in PCC, the cause of TBI, diagnosis, Glasgow Coma Scale score, Glasgow Outcome Scale score, Karnofsky Performance Status score, mobilization status, nutrition route (oral, percutaneous endoscopic gastrostomy), pressure ulcers, and discharge status. These patients were aged 45.4 ± 20.2 years. The median length of stay in the PCC was 34.0 days. These included TBI patients had a Glasgow Coma Scale score ≤ 8, were not mobilized, received tracheostomy and percutaneous endoscopic gastrostomy nutrition, and had pressure ulcers. No difference was found between those who were discharged to their home or other places (rehabilitation centre, intensive care unit and death) in respect of mobilization, percutaneous endoscopic gastrostomy, tracheostomy and pressure ulcers. TBI patients who were followed up in PCC were determined to be relatively young patients (45.4 ± 20.2 years) with mobilization and nutrition problems and pressure ulcer formation. As TBI patients have complex health conditions that require palliative care from the time of admittance to intensive care unit, provision of palliative care services should be integrated with clinical applications.