ABSTRACT
BACKGROUND: The demand of occupancy in neurosurgical intensive care unit (NICU) has extremely risen up in King Chulalongkorn Memorial Hospital but the intensive care personnel have not proportionally increased with the demand identifying especially for intensivists. The possible management that may be help to solve this problem is identifying the factors which may be involved in prolonging length of stay (LOS) in ICU and modifying of those risk factors. OBJECTIVE: To determine the factors which influenced the LOS in NICU. SETTING: Neurosurgical intensive care unit (NICU) in King Chulalongkorn Memorial Hospital which is the tertiary care hospital. RESEARCH DESIGN: A retrospective observational study MATERIAL AND METHOD: All data of NICU had been gathered over the period of October 1st, 2004 to December 31st, 2004. The patient characteristics; age, gender diagnosis, underlying diseases, and length of NICU stay were recorded. Postoperative events were stratified into 4 groups involving pulmonary complications, cardiovascular complications, neurological conditions and others. RESULTS: A total of 178 admissions utilized 605 ICU days. Short-stay patients (LOS < or = 3 days) accounted for 76.4% of total admissions which consumed only 32.1% of ICU days. The patients who were admitted between 3 to 14 days had 20.8% but mostly utilized 49.4% of ICU day. Cerebral aneurysm had the highest proportion (41.03%) in LOS more than 3 days group. The major causes of prolonged LOS are triple-H therapy (28%) and mechanical ventilation assisting (28%). CONCLUSION: The major causes of prolonged LOS are triple-H therapy and mechanical ventilation assisting in neurosurgical ICU. Early tracheotomy and using the proper weaning protocol might help reducing LOS in ICU with limited specific care procedure.
Subject(s)
Female , Humans , Critical Care/organization & administration , Length of Stay/statistics & numerical data , Male , Middle Aged , Nervous System Diseases/surgery , Neurosurgery/organization & administration , Postoperative Period , Respiration, Artificial , Retrospective Studies , Risk , Risk Assessment , Risk Factors , Thailand , Time FactorsABSTRACT
Objetivo: Demonstrar a maneira como foi implementado o Serviço de Alta Complexidade em Neurocirurgia num município da região metropolitana de Porto Alegre e seus resultados benéficos à população, aos neurocirurgiões e à Instituição Hospitalar. Material e método: São demonstrados os argumentos que o grupo de neurocirurgiões adotou para convencer a direção do Hospital Municipal de Novo Hamburgo(HMNH) a investir na especialidade antes mesmo de ter noção real das vantagens e dos lucros que adviriam. Resultados: Foi constatado que havia uma evasão mensal de aproximadamente 30 pacientes dos municípios que compunham a região para outro centro de referência (Hospital Referência). Essa evasão propiciaria um rendimento em torno de R$ 57 mil. Foi demonstrado que o Hospital Referência havia saltado de um faturamento de pouco mais de R$ 100 mil para aproximadamente R$ 500 mil após a implantação do Sipac-Neuro, e que a média de valores das autorizações de internações hospitalares(AIH) desse hospital era de R$ 1.056,12 contra R$ 382,84 do HMNH. A seguir, descrevem-se os passos que foram necessários para o credenciamento junto ao Ministério da Saúde, a implantação do serviço e os futuros investimentos que se pretende realizar em função dos novos aportes financeiros proporcionados pela Alta Complexidade. Os resultados financeiros iniciais após o credenciamento foram significativos. Conclusão: A organização e demonstração real, com exemplos de outras instituições,são instrumentos úteis e facilitadores para o convencimento das direções de hospitais que ainda são céticos quanto às vantagens proporcionadas pelo Sipac-Neuro.Administração hospitalar.
Objective: To present how a High Complexity Neurosurgical Service (accredited by the Ministry of Health denominated Sipac Neuro) was implemented in a public hospital of the metropolitan region of the city of Porto Alegre, Brazil. Material and method: The arguments used by the group of neurosurgeons that convinced the direction of the Hospital Municipal de Novo Hamburgo (HMNH) to invest on neurosurgery, before knowing the advantages and profit that would be generated is presented. Result: It was verified that there was an monthly evasion rate of approximately 30 patients from the regions covered by HMNH to other reference center (Reference hospital) during the year of 2001. This evasion would have yielded around R$ 57,000. It was demonstrated that the Reference hospital leaped from an income of around R$100,000 to around R$ 500,000 after the implementation of the Sipac-Neuro and that the average cost of Authorization for Hospitalization (AIH) at that hospital was R$ 1,056.12 compared to R$ 382.84at HMNH. The method of accreditation with the Ministry of Health is described here in, as well as the implementation of the Service and the future investments that are to be made as a result of the new financial resources as a result of this accreditation for high complexity. Conclusion: It is concluded that the organization and actual demonstration by means of the examples of other institutions is a useful and helpful tool to convince hospital administrations who remain skeptical as to the advantages obtained with a Sipac-Neuro.