Caring for critically ill patients outside intensive care units due to full units: a cohort study

OBJECTIVES: This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment. METHODS: A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint. RESULTS: Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98. CONCLUSIONS: Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Vivência de familiares de pacientes internados em unidades de terapia intensiva / The experience of family members of patients staying in intensive care units

OBJETIVOS: A proposta deste estudo é compreender as vivências de familiares de pacientes internados em unidade de terapia intensiva de hospital público e privado através de uma aproximação ao referencial da fenomenologia. MÉTODOS: Foram entrevistados 27 familiares de pacientes adultos, sendo 10 de instituição pública e 17 de instituição privada. RESULTADOS: Da análise das entrevistas da instituição pública emergiram quatro categorias temáticas. Na instituição privada somaram-se seis categorias. Na busca de suas semelhanças e diferenças quatro categorias temáticas foram encontradas nas duas instituições e apenas duas não emergiram no estudo do hospital público. CONCLUSÃO: Não há diferenças significativas das categorias dos hospitais público e privado, o que demonstra que a forma como a família vivencia a internação de um paciente na unidade de terapia intensiva não se relaciona a aspectos sociais ou financeiros. Entretanto, faz-se necessário um maior conhecimento de diretrizes e programas do governo federal que favorecem a humanização ao permitir o acompanhamento da família nos serviços terciários.

OBJECTIVE: The aim of this study was to understand the experience of family members, during a patient's stay in the intensive care unit of public and private hospitals using an approximation to the phenomenology referential. METHODS: We interviewed 27 relatives of adult patients, 10 from a public institution and 17 from a private one. RESULTS: From analyses of interviews in a public institution, four thematic categories emerged. In a private institution six categories were identified. Searching for differences and similarities, four similar thematic categories were perceived in both institutions and two categories were absent in the public hospital. CONCLUSION: There are no significant differences between categories in private and public hospitals. This indicates that family behavior and reactions to patient's admission to the ICU are not associated with social or financial aspects. However, a greater knowledge of government policies and programs is necessary, because they favor humanization by allowing family members to accompany the patient in tertiary services.