河南省县级综合医院ICU现状调查

Study on present status of ICU in county-level general hospitals of Henan Province

目的调查河南省县级综合医院重症医学科的建设现状,为提高重症医学科建设水平和医疗资源合理配置提供依据。方法依据原卫生部印发的《重症医学科建设与管理指南(试行)》(下文简称"指南"),采用自行设计的医院重症医学科现状调查问卷,对河南省93家县级综合医院2018年重症监护病房(ICU)运行现状进行横断面调查,调查内容包括ICU基本情况(成立时间、组织管理模式、专科ICU开展情况、重点学科建设)、ICU规模及人员配置和人才培养、ICU设备及技术开展情况。结果ICU基本情况方面:首先是ICU成立时间,河南省县级综合医院ICU起步较晚,被调查的93家医院均设置了ICU,其中成立最早的是1989年浚县人民医院ICU,2000年之前成立ICU的县级综合医院仅有4家,2009年前有34家;其次是ICU组织管理模式,本次调查显示,河南省县级综合医院ICU实行封闭管理的比例为68.82%(64/93),半开放管理的比例为18.28%(17/93),仍有12.90%(12/93)的医院采取开放管理模式;再次是专科ICU开展与重点学科建设,本次调查显示,86家医院开放了综合ICU,专科ICU开放比例较高的是新生儿ICU、急诊ICU和冠心病监护室(CCU);8家医院ICU是河南省卫生健康委员会(卫健委)重点学科,9家医院ICU是地级市卫健委重点学科。ICU规模及人员配置方面:本次调查的93家县级综合医院共开放ICU床位2189张,ICU床位使用率和ICU每床位使用面积达标率较高,分别为76.34%、80.64%,而ICU医师数/ICU床位数、ICU护士数/ICU床位数达标率低,分别为8.60%和7.52%,说明医护配备不足。被调查医院包含三级医院1家、二级甲等医院76家、二级乙等医院16家,二级甲等医院总床位数(张:922.22±285.99比636.75±258.84)、ICU床位数(张:25.28±21.15比14.63±6.89)均明显多于二级乙等医院(均P<0.01),床位使用达标率明显高于二级乙等医院〔81.6%(62/76)比50.0%(8/16),P<0.01〕;人员配置上,ICU医生和护士职称以初级所占比例最高,正高级职称比例较低,医生学历以本科所占比例最高,护士学历以大专所占比例最高;人才培养上,接受调查的医院派出参加省级或省级以上重症医学继续教育和培训的医生和护士最多,分别为745人次和1156人次,平均每家医院分别为8人次和12人次。ICU设备配置和技术开展方面,县级综合医院ICU配备最多的设备是微量注射泵、监护仪、输液泵、有创呼吸机、排痰机等,但总体设备配备不足;虽有1家医院引入了体外膜肺氧合(ECMO)设备,但没有开展临床应用。河南省所有县级综合医院均设置了ICU,但是多项指标达标率与"指南"要求存在差距,人员及设备相对不足。结论河南省县级综合医院ICU近年来快速发展,但仍有较大提升空间。

Objective To investigate the present status of intensive care unit(ICU)in the county-level general hospitals of Henan Province and provide basis for improving the construction level and rational allocation of medical resources of ICU.Methods According to The guidelines for the construction and management of critical care medicine(trial implementation)issued by National Health Commission(NHC)(hereinafter referred as the guidelines),a cross-sectional survey was conducted on the present status of ICU in 93 county-level general hospitals in Henan Province in 2018 by using a self-designed questionnaire concerning this topic.The survey included the basic information of ICU(establishment time,organization and management mode,development of special departments in ICU,construction of key disciplines),scale and staffing allocation and training,and the equipment and technology development situation in ICU.Results The basic aspects of ICU situation were as follows:firstly,the establishment time:the ICU of county-level general hospitals in Henan Province started relatively late.The survey showed that all the 93 hospitals had set up ICU,of which the earliest was the ICU of Xunxian People's Hospital in 1989,only 4 county-level general hospitals established their ICUs before 2000,and 34 before 2009.Secondly,the management mode:the proportion of ICU closely managed was accounting for 68.82%(64/93),while semi-open management was 18.28%(17/93),and 12.90%(12/93)hospitals still adopted the open management mode.Thirdly,development of specialized ICU and construction of key disciplines:comprehensive ICUs were founded in 86 hospitals,and the proportions of specialized ICUs such as neonatal ICU,emergency ICU and coronary heart disease care unit(CCU)were higher than other kinds of special department;the ICUs of 8 hospitals were the key discipline of Henan Provincial Health Commission,and the ICUs of 9 hospitals were the discipline of Municipal Health Commission.Scale and staffing of ICU:a total of 2189 ICU beds were opened in 93 county-level general hospitals.The utilization rate reaching the targets of ICU beds and the compliance rate of ICU bed area per bed were relatively high,76.34%and 80.64%,while the compliance rates of ICU doctors/ICU beds,ICU nurses/ICU beds were low,which were 8.60%and 7.52%respectively,indicating that the clinicians and nursing facilities were insufficient.There were 1 tertiary hospital,76 secondary-A hospitals and 16 secondary-B hospitals in this survey.Compared with secondary-B hospitals in the total number of beds(sheets:922.22±285.99 vs.636.75±258.84)and ICU beds(sheets:25.28±21.15 vs.14.63±6.89),the secondary-A hospitals were significantly higher(all P<0.01),and the rate of bed use compliance of secondary-A hospitals was significantly higher than that in secondary-B hospitals[81.6%(62/76)vs.50.0%(8/16),P<0.01].In terms of staffing,the proportion of clinicians and nurses with elementary titles was the highest,the proportion of full-time senior professional titles was relatively low,the proportion of doctors with bachelor's degree was the highest,and that of nurses with junior college degree was the highest.In personnel training,the hospitals surveyed had sent the doctors and nurses mostly to participate in the continuing education and training of critical care medicine at or above the provincial level for 745 person-times and 1156 person-times,and there were in the mean for 8 and 12 person-times in each hospital,respectively.In terms of equipment configuration and technology development of ICU,mostly the equipment in ICU of county-level general hospitals consisted of microinjection pump,monitor,infusion pump,invasive ventilator,expectorant machine,etc.but the overall equipment was insufficient.Although an extracorporeal membrane oxygenation(ECMO)equipment was introduced in one hospital,it had not been carried out clinically.All county-level general hospitals in Henan Province had set up ICUs,but there were gaps between the compliance rates of many indicators and the requirements of the guidelines,and the medical personnel and equipment were relatively insufficient.Conclusion The ICUs of county-level general hospitals in Henan Province have developed rapidly in recent years,but there is still much room for improvement.