Marcio Soares1, Fernando A Bozza2, Luciano C P Azevedo2, Ulysses V A Silva2, Thiago D Corrêa2, Fernando Colombari2, André P Torelly2, Pedro Varaschin2, William N Viana2, Marcos F Knibel2, Moyzés Damasceno2, Rodolfo Espinoza2, Marcus Ferez2, Juliana G Silveira2, Suzana A Lobo2, Ana Paula P Moraes2, Ricardo A Lima2, Alexandre G R de Carvalho2, Pedro E A A do Brasil2, Jeremy M Kahn2, Derek C Angus2, Jorge I F Salluh2. 1. Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA. marciosoaresms@gmail.com. 2. Marcio Soares, Fernando A. Bozza, Pedro E.A.A. do Brasil, and Jorge I.F. Salluh, D'Or Institute for Research and Education; Fernando A. Bozza and Pedro E.A.A. do Brasil, Instituto Nacional de Infectologia Evandro Chagas, Instituto Oswaldo Cruz-Fiocruz; Pedro Varaschin, Hospital Pasteur; William N. Viana, Hospital Copa D'Or; Marcos F. Knibel, Hospital São Lucas Copacabana; Rodolfo Espinoza, Hospital do Câncer II-Instituto Nacional de Câncer; Juliana G. Silveira, Hospital Quinta D'Or; Ricardo A. Lima, Hospital Samaritano, Rio de Janeiro; Luciano C.P. Azevedo, Hospital Sírio-Libanês; Thiago D. Corrêa, Hospital Israelita Albert Einstein; Fernando Colombari, Hospital Alemão Oswaldo Cruz, São Paulo; Ulysses V.A. Silva, Fundação Pio XII-Hospital de Câncer de Barretos, Barretos; André P. Torelly, Complexo Hospitalar, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre; Moyzés Damasceno, Complexo Hospitalar de Niterói, Niterói; Marcus Ferez, Hospital São Francisco, Ribeirão Preto; Suzana A. Lobo, Hospital de Base de São José do Rio Preto, São José do Rio Preto; Ana Paula P. Moraes, Hospital de Câncer do Maranhão Dr Tarquinio Lopes Filho; Alexandre G.R. de Carvalho, UDI Hospital, São Luís, Brazil; Jeremy M. Kahn, University of Pittsburgh Graduate School of Public Health; and Jeremy M. Kahn and Derek C. Angus, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Abstract
PURPOSE: To investigate the impact of organizational characteristics and processes of care on hospital mortality and resource use in patients with cancer admitted to intensive care units (ICUs). PATIENTS AND METHODS: We performed a retrospective cohort study of 9,946 patients with cancer (solid, n = 8,956; hematologic, n = 990) admitted to 70 ICUs (51 located in general hospitals and 19 in cancer centers) during 2013. We retrieved patients' clinical and outcome data from an electronic ICU quality registry. We surveyed ICUs regarding structure, organization, staffing patterns, and processes of care. We used mixed multivariable logistic regression analysis to identify characteristics associated with hospital mortality and efficient resource use in the ICU. RESULTS: Median number of patients with cancer per center was 110 (interquartile range, 58 to 154), corresponding to 17.9% of all ICU admissions. ICU and hospital mortality rates were 15.9% and 25.4%, respectively. After adjusting for relevant patient characteristics, presence of clinical pharmacists in the ICU (odds ratio [OR], 0.67; 95% CI, 0.49 to 0.90), number of protocols (OR, 0.92; 95% CI, 0.87 to 0.98), and daily meetings between oncologists and intensivists for care planning (OR, 0.69; 95% CI, 0.52 to 0.91) were associated with lower mortality. Implementation of protocols (OR, 1.52; 95% CI, 1.11 to 2.07) and meetings between oncologists and intensivists (OR, 4.70; 95% CI, 1.15 to 19.22) were also independently associated with more efficient resource use. Neither admission to ICUs in cancer centers compared with general hospitals nor annual case volume had an impact on mortality or resource use. CONCLUSION: Organizational aspects, namely the implementation of protocols and presence of clinical pharmacists in the ICU, and close collaboration between oncologists and ICU teams are targets to improve mortality and resource use in critically ill patients with cancer.
PURPOSE: To investigate the impact of organizational characteristics and processes of care on hospital mortality and resource use in patients with cancer admitted to intensive care units (ICUs). PATIENTS AND METHODS: We performed a retrospective cohort study of 9,946 patients with cancer (solid, n = 8,956; hematologic, n = 990) admitted to 70 ICUs (51 located in general hospitals and 19 in cancer centers) during 2013. We retrieved patients' clinical and outcome data from an electronic ICU quality registry. We surveyed ICUs regarding structure, organization, staffing patterns, and processes of care. We used mixed multivariable logistic regression analysis to identify characteristics associated with hospital mortality and efficient resource use in the ICU. RESULTS: Median number of patients with cancer per center was 110 (interquartile range, 58 to 154), corresponding to 17.9% of all ICU admissions. ICU and hospital mortality rates were 15.9% and 25.4%, respectively. After adjusting for relevant patient characteristics, presence of clinical pharmacists in the ICU (odds ratio [OR], 0.67; 95% CI, 0.49 to 0.90), number of protocols (OR, 0.92; 95% CI, 0.87 to 0.98), and daily meetings between oncologists and intensivists for care planning (OR, 0.69; 95% CI, 0.52 to 0.91) were associated with lower mortality. Implementation of protocols (OR, 1.52; 95% CI, 1.11 to 2.07) and meetings between oncologists and intensivists (OR, 4.70; 95% CI, 1.15 to 19.22) were also independently associated with more efficient resource use. Neither admission to ICUs in cancer centers compared with general hospitals nor annual case volume had an impact on mortality or resource use. CONCLUSION: Organizational aspects, namely the implementation of protocols and presence of clinical pharmacists in the ICU, and close collaboration between oncologists and ICU teams are targets to improve mortality and resource use in critically illpatients with cancer.
Authors: Fernando G Zampieri; Jorge I F Salluh; Luciano C P Azevedo; Jeremy M Kahn; Lucas P Damiani; Lunna P Borges; William N Viana; Roberto Costa; Thiago D Corrêa; Dieter E S Araya; Marcelo O Maia; Marcus A Ferez; Alexandre G R Carvalho; Marcos F Knibel; Ulisses O Melo; Marcelo S Santino; Thiago Lisboa; Eliana B Caser; Bruno A M P Besen; Fernando A Bozza; Derek C Angus; Marcio Soares Journal: Intensive Care Med Date: 2019-10-08 Impact factor: 17.440
Authors: Elie Azoulay; Peter Schellongowski; Michael Darmon; Philippe R Bauer; Dominique Benoit; Pieter Depuydt; Jigeeshu V Divatia; Virginie Lemiale; Maarten van Vliet; Anne-Pascale Meert; Djamel Mokart; Stephen M Pastores; Anders Perner; Frédéric Pène; Peter Pickkers; Kathryn A Puxty; Francois Vincent; Jorge Salluh; Ayman O Soubani; Massimo Antonelli; Thomas Staudinger; Michael von Bergwelt-Baildon; Marcio Soares Journal: Intensive Care Med Date: 2017-07-19 Impact factor: 17.440
Authors: Andrew S Epstein; Andrew Yang; Lauren E Colbert; Louis P Voigt; Jason Meadows; Jessica I Goldberg; Leonard B Saltz Journal: J Intensive Care Med Date: 2017-12-20 Impact factor: 3.510