title: Measuring complexity/level of care and appropriateness of resource use in intensive care units.
abstract: BACKGROUND
  Throughout the world, the cost of critical care medicine is increasing more than the overall health care cost. Thus, a higher attention to improve the efficiency of the use of ICU resources is indispensable. The objective of this study was the development of a simple and reliable tool for the evaluation of the appropriateness of ICU utilization.
  
  
  METHODS
  
  
  
  METHODS
  A repeated cross-sectional data collection was performed twice a week, during a 61-day study period.
  
  
  METHODS
  Twenty-three Italian general ICUs.
  
  
  METHODS
  All patients present in the 23 ICUs on the 17 index days.
  
  
  METHODS
  On each index day, patients were checked for receiving ventilation/CPAP, pulmonary arterial pressure monitoring, intracranial pressure monitoring, vaso-active drug infusion and hemodialysis-ultrafiltration. Simultaneously, each ICU bed was assessed for its technical and personnel facilities in order to estimate the deliverable level of care.
  
  
  RESULTS
  A total of 1250 patients were studied, for a total number of 7533 patient-days. The overall occupancy rate per ICU was 83.8% (-range: 54.4% to 96.1%). The high-level occupancy rate (rate of patients requiring high level of care and actually occupying high-facility beds) was 69.4% (range: 25.0% to 149.0%), while the corresponding low-level occupancy rate was 101.1% (range: 31.3% to 329.4%).
  
  
  CONCLUSIONS
  Our model clearly showed up a certain degree of inappropriateness in the use of ICU resources. Most of the ICUs (69.6%) used a very large proportion of their high-facility beds for patients who did not need high-level care. Being very simple, our method could represent a useful tool for continuous evaluation of the appropriateness of resource utilization in the ICU.
authors.affiliation: Istituto di Ricerche Farmacologiche Mario Negri. g.iapichino@unimi.it
authors.forename: G
authors.initials: G
authors.lastname: Iapichino
authors.forename: A
authors.initials: A
authors.lastname: Pezzi
authors.forename: C
authors.initials: C
authors.lastname: Minelli
authors.forename: D
authors.initials: D
authors.lastname: Radrizzani
authors.forename: B
authors.initials: B
authors.lastname: Barberis
authors.forename: G
authors.initials: G
authors.lastname: Belloni
authors.forename: P
authors.initials: P
authors.lastname: Bianchi
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D007558:Italy; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational