title: Variability of structures in German intensive care units--a representative, nationwide analysis.
abstract: BACKGROUND
  Structures in intensive care medicine comprise human as well as material resources, organization, and management and may be related to processes thereby affecting patients' outcomes. Utilizing a unique data base we evaluated structures of German intensive care units (ICUs).
  
  
  METHODS
  The study was carried out by the German Competence Network Sepsis (SepNet). Data were prospectively collected on a cross-sectional basis in a representative random sample of German hospitals utilizing a questionnaire. Structures were related to ICU outcome of patients with severe sepsis or septic shock. The sample was subdivided in 5 strata according to hospital size.
  
  
  RESULTS
  A total of 454 ICUs cared for 3877 patients including 415 patients (11%) with severe sepsis or septic shock. The mean number of beds per ICU was 10.4, the ratio of ICU to hospital beds 1:27, both with significant differences depending on hospital size. 81% of the ICUs provided around the clock physician presence (range: 66-98% across hospital strata, p < 0.001). Shift-wise, one nurse was responsible for a mean number of 2.7 patients (morning 1:2.3, afternoon 1:2.6, night 1:3.3 patients) with significant variation according to hospital size (smaller hospitals 1:2.9, university hospitals 1:2.1, p < 0.001). More than half of all German ICUs are lead by anesthesiologists. Neither physician nor nurse staffing was associated with mortality in the subset of patients with sepsis.
  
  
  CONCLUSIONS
  In a representative, nationwide sample of German ICUs key elements of structures varied considerably with respect to hospital size. This has to be considered when proposing standards, reimbursement strategies, or quality assessment.
authors.affiliation: Aero Medical Centre Frankfurt, Lufthansa AG, Frankfurt, Germany. juergen.graf@dlh.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Graf
authors.forename: Andrea
authors.initials: A
authors.lastname: Reinhold
authors.forename: Frank M
authors.initials: FM
authors.lastname: Brunkhorst
authors.forename: Max
authors.initials: M
authors.lastname: Ragaller
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Markus
authors.initials: M
authors.lastname: Loeffler
authors.forename: Christoph
authors.initials: C
authors.lastname: Engel
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D018805:Sepsis / Q000453:epidemiology* / Q000628:therapy*; D016526:Workload / Q000706:statistics & numerical data*