title: The impact of hospital and ICU organizational factors on outcome in critically ill patients: results from the Extended Prevalence of Infection in Intensive Care study.
abstract: OBJECTIVE
  To investigate the impact of various facets of ICU organization on outcome in a large cohort of ICU patients from different geographic regions.
  
  
  METHODS
  International, multicenter, observational study.
  
  
  METHODS
  All 1,265 ICUs in 75 countries that contributed to the 1-day point prevalence Extended Prevalence of Infection in Intensive Care study.
  
  
  METHODS
  All adult patients present on a participating ICU on the study day.
  
  
  METHODS
  None.
  
  
  RESULTS
  The Extended Prevalence of Infection in Intensive Care study included data on 13,796 adult patients. Organizational characteristics of the participating hospitals and units varied across geographic areas. Participating North American hospitals had greater availability of microbiologic examination and more 24-hour emergency departments than did the participating European and Latin American units. Of the participating ICUs, 82.9% were closed format, with the lowest prevalence among North American units (62.7%) and the highest in ICUs in Oceania (92.6%). The proportion of participating ICUs with 24-hour intensivist coverage was lower in North America than in Latin America (86.8% vs 98.1%, p = 0.002). ICU volume was significantly lower in participating ICUs from Western Europe, Latin America, and Asia compared with North America. In multivariable logistic regression analysis, medical and mixed ICUs were independently associated with a greater risk of in-hospital death. A nurse:patient ratio of more than 1:1.5 on the study day was independently associated with a lower risk of in-hospital death.
  
  
  CONCLUSIONS
  In this international large cohort of ICU patients, hospital and ICU characteristics varied worldwide. A high nurse:patient ratio was independently associated with a lower risk of in-hospital death. These exploratory data need to be confirmed in large prospective studies that consider additional country-specific ICU practice variations.
authors.affiliation: 1Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany. 2Department of Critical Care, St George's Healthcare NHS Trust, London, United Kingdom. 3Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, Canada. 4Center for Clinical Research and Scholarship, Rush University Medical Center, Chicago, IL. 5Department of Intensive Care, Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. 6Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands. 7Department of Intensive Care Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands. 8Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Queensland, Australia. 9Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Cora L
authors.initials: CL
authors.lastname: Moreira
authors.forename: Andrew
authors.initials: A
authors.lastname: Rhodes
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Ruth
authors.initials: R
authors.lastname: Kleinpell
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D018806:APACHE; D000367:Age Factors; D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D014943:Global Health; D059066:Gross Domestic Product; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012737:Sex Factors