| Objective:To explore the situation of Emergency Intensive Care Unit(EICU)of comprehensive hospitals in Zhejiang province,and to provide evidence for further measures to improve the emergency and critical care service.Methods:It was a multi-center cross-sectional study,which was surveyed among hospitals of the 11 districts in Zhejiang province.The survey date was March 1-31,2018.The questionnaire was developed by three senior experts,all with rich experience in emergency medical quality control and management.Content of the questionnaire contained five parts,including the basic information of the hospital and emergency department(hospital level,whether university hospital or not,the total number of hospital rated beds,ICU and EICU beds and area,etc.);the situation of EICU fixed hardware facilities(such as monitor,Medical ventilator,bronchofiberscope,ultrasound,etc);the basic information of the EICU medical staff(the number of doctor/nurse,title,and scheduling model,etc.);Technology in EICU and basic information of admitted patients(the number of patients,diagnosis,length of hospital stay,and outcome).Describe the situation of the EICU and compare the differences among different district and levels/types of hospitals.Results:(1)A total of 169 comprehensive hospitals were enrolled,which covered most of the hospitals at county level and above,and the results might reflect the overall situation of Zhejiang province.Among them,50 hospitals were third level grade-A hospitals,41 were third level grade-B hospitals and 78 were second level hospitals.Besides,59 hospitals were university affiliated and 110 were non-affiliated hospitals.135 hospitals were western hospitals,11 were integrated Chinese and western medicine hospitals and 23 were Chinese medicine hospitals.The median number of rated beds of these 169 hospitals was 1,000(800,1,300),and the median number of rated beds of these emergency departments was 42(26,66).(2)Among these 169 hospitals,90 hospitals(53.3%)have established EICU.Among them,the EICU construction proportion of the third level grade-A hospitals was 88%,third level grade-B hospitals was 70.7%,and second level hospitals was 21.8%.The difference had statistical significance(?2=60.3,P<0.05).The proportion had no significant differences among western medicine,Chinese medicine and western medicine hospitals(?2=1.8,P=0.41).While the EICU construction proportion of affiliated hospitals was significantly higher than that of non-affiliated hospitals,which was 86.4%and 35.5%respectively(?2=40.1,P<0.05).Through multivariate regression analysis,it was found that the construction rate of EICU was associated with hospital levels and university affiliation(OR=4.59,2.10 and 3.64,all P<0.05).The average construction time of EICU was in the year of 2012(2010,2015),and there was no significant difference in the construction time of EICU between different levels of hospitals(all P>0.05).The average number of beds in EICU was 7(4,12),with an area of 240(100,550)m2.Of which,the number and area of beds in Chinese medicine hospitals was less than that in western hospitals and integrated hospitals(?2=12.38 and 10.13,P=0.002 and 0.006).There was no significant difference in the number and area of EICU between different levels of hospitals and affiliated hospitals(al P>0.05).(3)Usual fixed hardware facilities,such as multifunction monitor,ventilator,bedside blood glucose monitoring,transfer monitor,glidescope,transfer ventilator,ice blanket,and bedside radiography machine,had a relatively high allocation rates,with an average of more than 80%.The allocation rates of the bedside ultrasound machine,non-invasive ventilator,PICCO machine/module,specialized transporter bed,non-invasive hemodynamic monitor,CRRT,antithrombotic pump,portable bronchofiberscope and blood gas analyzer were between 50?80%.The facilities with lower allocation rates included ECMO machine,bedside metabolism monitor,bedside continuous glucose monitor,bedside continuous monitor and gastroscope.There was no significant difference in the rates of the usual facilities between different levels of hospitals,only some kinds of the facilities,such as bedside ultrasound and ECMO machines,had a difference in the allocation proportion(?2=4.89 and 14.49,P=0.001 and 0.01).(4)The median number of EICU doctors and nurses was 6(4,7)and 13(9,24).Most of EICU's scheduling mode was long-term or monthly,and there was no significant difference in the number of medical staff and scheduling modes between diff erent levels of hospitals.(5)Usual technical operations in these EICUs,such as deep venipuncture,hypothermia therapy were very common.Compared to second level hospitals,the implement proportions of the third level hospitals were higher in the placement of nasointestinal tube,bronchofiberscope operation,screening for venous thromboembolism,CRRT,bedside temporary pacemakers,intracranial pressure monitoring(x2 were 6.79,7.98,7.98,6.45,7.22 and 8.15,P<0.05).Compared with non-affiliated hospitals,there were relatively higher operation rates in the rehabilitative evaluation,bedside temporary pacemaker treatment and intra-aortic balloon pumping(?2=6.05,6.05 and 5.08,P<0.05,respectively).(6)The median number of patients admitted to the 90 EICUs was 204(80,426).Among them,the number of patients admitted to EICU of the third level grade-A hospitals was significantly higher than that of the third level grade-B hospitals and the second level hospitals(?2=36.1,P<0.05).The top three main diseases admitted into EICUs were pneumonia accompanied by respiratory failure,stroke and severe trauma,with numbers of 57(29,92),54(21,72)and 65(38,103),respectively.Among them,the number of patients admitted to EICUs in the third level grade-A hospitals was higher than that in the third level grade-B hospitals and the second level hospitals(?2=21.5,P<0.05).Among these patients,62.2%of the patients were transferred to general wards,and the inpatient mortality was 11.2%.Besides,the rate of transferring to general wards(71.4%)of third level grade-A hospitals was higher than that of third level grade-B hospitals(60.1%)and second level hospitals(58.9%)(?2=107.5,P<0.05).Conclusion:The proportion of EICU construction in these 169 comprehensive hospitals was 53.3%,while the proportion was lower in second level hospitals.The allocation rates of usual fixed facilities of EICU were about 80%.The major patients admitted to these EICUs were mainly pneumonia accompanied by respiratory failure,stroke and severe trauma.More attention should be paid on the outcomes of these patients. |
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