BACKGROUND: The aim of this study was to verify the capability of the Italian Group for the Evaluation of Intervention in Intensive Care Medicine (Gruppo Italiano Valutazione Interventi in Terapia Intensiva, GiViTI) Intensive Care Units (ICUs) in providing high level care (HLC) and to develop a flexible organiziational model, allowing for different levels of care in each ICU. METHODS: Once the number of active beds, personnel and technology of each ICU were determined, we computed whether the available bed number and all available resources could provide HLC according to international standards. For ICUs lacking staff or equipment for safe HLC in all declared beds, we calculated the best combination between HLC and observation/monitoring beds with less need for nurses and technology (low level of care, LLC) in order to optimise the utilization of each bed. We also investigated the work organisation of physicians and nurses in these units. RESULTS: There are 2 070 available beds in the 293 GiViTI ICUs. To provide HLC according to international criteria, the beds would decrease to 80.9%, because 144 ICUs do not have nurses or equipment to provide HLC in each bed. In order to maximize the suitable use of available resources, these ICUs would have to reduce the HLC bed number using the regained nurse workload for LLC. Because of this, the total number of HLC beds would further decrease to 65.9% of all declared beds. During Sundays and holidays, the bed/doctor and the bed/nurse ratios increase in most ICUs. CONCLUSION: To maximize the staff and equipment resources available, the bed numbers of a general ICU providing HLC must vary, even daily, according to the level of care provided. This level is not always high for all patients present. Applying this organizing model to each ICU, we could have enough flexibility to face the different demands for assistance if the ICU is built as a large open space to achieve the best clinical model and use of resources.
BACKGROUND: The aim of this study was to verify the capability of the Italian Group for the Evaluation of Intervention in Intensive Care Medicine (Gruppo Italiano Valutazione Interventi in Terapia Intensiva, GiViTI) Intensive Care Units (ICUs) in providing high level care (HLC) and to develop a flexible organiziational model, allowing for different levels of care in each ICU. METHODS: Once the number of active beds, personnel and technology of each ICU were determined, we computed whether the available bed number and all available resources could provide HLC according to international standards. For ICUs lacking staff or equipment for safe HLC in all declared beds, we calculated the best combination between HLC and observation/monitoring beds with less need for nurses and technology (low level of care, LLC) in order to optimise the utilization of each bed. We also investigated the work organisation of physicians and nurses in these units. RESULTS: There are 2 070 available beds in the 293 GiViTI ICUs. To provide HLC according to international criteria, the beds would decrease to 80.9%, because 144 ICUs do not have nurses or equipment to provide HLC in each bed. In order to maximize the suitable use of available resources, these ICUs would have to reduce the HLC bed number using the regained nurse workload for LLC. Because of this, the total number of HLC beds would further decrease to 65.9% of all declared beds. During Sundays and holidays, the bed/doctor and the bed/nurse ratios increase in most ICUs. CONCLUSION: To maximize the staff and equipment resources available, the bed numbers of a general ICU providing HLC must vary, even daily, according to the level of care provided. This level is not always high for all patients present. Applying this organizing model to each ICU, we could have enough flexibility to face the different demands for assistance if the ICU is built as a large open space to achieve the best clinical model and use of resources.
Authors: Gaetano Iapichino; Davide Corbella; Cosetta Minelli; Gary H Mills; Antonio Artigas; David L Edbooke; Angelo Pezzi; Jozef Kesecioglu; Nicolò Patroniti; Mario Baras; Charles L Sprung Journal: Intensive Care Med Date: 2010-06-09 Impact factor: 17.440
Authors: Maurizia Capuzzo; Carlo Volta; Tania Tassinati; Rui Moreno; Andreas Valentin; Bertrand Guidet; Gaetano Iapichino; Claude Martin; Thomas Perneger; Christophe Combescure; Antoine Poncet; Andrew Rhodes Journal: Crit Care Date: 2014-10-09 Impact factor: 9.097
Authors: Narendra Rungta; Kapil Gangadhar Zirpe; Subhal B Dixit; Yatin Mehta; Dhruva Chaudhry; Deepak Govil; Rajesh C Mishra; Jeetendra Sharma; Pravin Amin; B K Rao; G C Khilnani; Kundan Mittal; Pradip Kumar Bhattacharya; A K Baronia; Yash Javeri; Sheila Nainan Myatra; Neena Rungta; Ranvir Tyagi; Sanjay Dhanuka; Mahesh Mishra; Srinivas Samavedam Journal: Indian J Crit Care Med Date: 2020-01