مقایسه عملکرد بخشهای مراقبت ویژه براساس میزان مرگ و میر و استانداردهای ساختاری در بیمارستانهای آموزشی

Aims: The aim of intensive care units of the hospitals is decreasing mortality rate and improving health of the society. This study was done with the aim of “studying and comparing the performance of intensive care units by determining mortality rate and finding its relationship with structural situation of these units”. Methods: This cross-sectional study was done during six months in ۲۰۱۱ in the intensive care units of educational hospitals in Hamadan. The study was done on ۲۰۰ patients through convenient sampling in the intensive unit of Besat hospital and in two intensive care units of Shahid Beheshti hospital. Data collection tools included SAPS۳ checklist that its validity and reliability were confirmed in different studies and a researcher-made structural standards checklist in three areas (human force, physical environment and medical equipment). The ratio of the actual death to the expected death (SMR: standardized mortality rate) was determined by SAPS۳ and its relationship with the structural standard score was measured. For data analysis, Kruskal-Wallis, Mann-Whitney, chi-square and Spearman correlation coefficient and SPSS۱۷ software were used. Results: Based on the SAPS۳ scoring system, the ration of the actual death to the expected death (SMR) was more than one in all the units of the study which means weak performance in a way that SMR of Besat, Ghaem and Milad units were respectively ۲.۲۹, ۱.۳۸ and ۱.۵۶. Structural situation score of the units of the study were also less than ۵۰% of the standard in a way that Besat, Ghaem and Milad units had respectively ۴۸%, ۴۵% and ۴۱% of the structural standards scores. There was no significant relationship between structural standards scores of the units of the study and their SMR performance score (p=۰.۶۶). Conclusions: Performance score of all the three units was weak and regarding structural standards the mentioned units were less than moderate. It is necessary to try to improve structural standards and to decrease ratio of the actual death to the amount of death expected by managers, physicians, nurses and other staff of the intensive care units.