General Situation Comparison Between Second-class And Above Hospitals From Xinjiang Production And Construction Corps (XPCC) And The Xinjiang Uygur Autonomous Region On Comprehensive Intensive Care Unit (ICU)

Objective: Promote the development of critical care medicine of XPCC,making clear the resource distribution and the difference between XPCC and autonomous region on developmental level of comprehensive ICU based on the countrywide ICU survey data.Methods: 17 comprehensive ICUs from 16 second-class and above hospitals(including second-class)of XPCC were involved,from Apr,30 th,2014 to Apr,30 th,2015,the general construction of above ICUs were investigated by questionnaire,mainly including the basical situation of hospital,basical situation of ICUs,ICU staffs,ICU device configuration,ICU management,ICU technical ability.Results: 17 questionnaires were given out and taken back,retrieving rate 100%.1)Basical information of medical establishment: 16 hospitals from XPCC included in this survey were predominated by comprehensive grade 2A hospital.2)Basical information of ICU: 17 ICUs totally had 174 beds,accounting for 1.65% of all the beds in hospital,which is lower than the number of autonomous region(1.85%).Ratio of ICU beds to total beds in great-3A hospitals in XPCC was respectively 2.00% and 1.75%.3)Situation of ICU staffs: 5 XPCC ICUs' doctor-bed-ratio reached up to 0.8:1(reaching standard was29.41%),all grade-2A hospital comprehensive ICUs over the standard(33.33%),however the grade-3class hospitals failed to reach the standard.The doctors of ICU from XPCC had a good gradient constitution of professional title.Majority of doctors from XPCC ICU got bachelor degree,those who got master degree and above were relatively few.The percentage of XPCC ICU doctors who got master degree and above was 19.27%,which is much less than the number of autonomous region(25.37%).Comprehensive ICU from Great 3A-hospitals accounted for 17.64% of 17 XPCC ICUs,including 36.36%of chief physicians,100% of doctors and 85% of masters of overall XPCC ICU staffs.It shows that there is a serious imbalance in the distribution of ICU high professional and high education talents between XPCC and autonomous region ICUs.4)Situation of ICU equipment: According to the standard of Guideline For Construction and Management of ICU(2009),70.59% of XPCC ICUs reached the standard at portable monitor technology,noninvasive ventilator(76.47%),portable breathing machine(41.18%),and micro-injection pump was only 11.76%.However,blood-gasanalyzer,detector of cardiac markers,PTC detector,bronchoscope,bedside ultrasound,and mechanical insufflation-exsufflation were relatively low.Otherwise,intra-aortic balloon pump and extracorporeal membrane oxygenation were still not equipped in XPCC ICUs.All the date indicated that the software infrastructure and related-ICU equipment still needed to be enhanced.5)ICU quality management: 14 comprehensive ICUs from XPCC took overall closed-off management strategy,3 comprehensive ICUs took semi-closed management strategy.All XPCC ICUs were equipped with full-time staff responsible for hospital infection quality control.All XPCC ICUs had wash basins,and taking drug-resistant patients quarantine strategy.Most ICUs of XPCC equipped with dry toilet paper(device)and non manual hand washing switch.All ICUs doctors could do regular corps to raise the bed,antibiotic used in patients with septic shock within 1 hours;most ICUs doctors prefer to use noradrenaline for septic shock to maintain MAP,use lung recruitment maneuver for ARDS patient,use APACHE ?evaluation system to estimate critical patient.One nurse need to care for more than one patients during the daytime,but need to care for more than two patients during the night in most of comprehensive ICUs of XPCC.Majority of patients from XPCC ICUs were given general light sedation and analgesia,and only one of the ICUs' patients were given general deep sedation.The ratio of ICU electronic medical records and PDA using in XPCC ICUs were low.6)Situation of ICU technical skills: XPCC ICUs doctors can do better in deep vein puncture,common and difficult intubation,hemodynamic monitoring,CVP and other aspects,but in the terms of dynamic monitoring of blood glucose by using blood glucose meter,jejunum nutrition,bronchoscope examination,high frequency oscillation for respiratory therapy strategy,the ratio were low..Only one comprehensive ICU from XPCC could accomplish ECMO,PEG,PEJ,PICCO and gastrointestinal endoscope check and treatment technology.However,there was still no ICU of XPCC could finish IABP technology.Conclusion: there is still a large gap between XPCC and national standard,and also still a significant disparity between XPCC and autonomous region on ICUs comprehensive situation.Further standardization construction is still needed in order to improve the technology level of diagnosis and treatment.