This quality improvement initiative in sepsis in an emerging country was associated with a reduction in mortality and with improved compliance with quality indicators. However, this reduction was sustained only in private institutions.
Objective
To characterize resource availability from a nationally representative random
sample of intensive care units in Brazil.
Methods
A structured online survey of participating units in the Sepsis PREvalence
Assessment Database (SPREAD) study, a nationwide 1-day point prevalence
survey to assess the burden of sepsis in Brazil, was sent to the medical
director of each unit.
Results
A representative sample of 277 of the 317 invited units responded to the
resources survey. Most of the hospitals had fewer than 500 beds (94.6%) with
a median of 14 beds in the intensive care unit. Providing care for
public-insured patients was the main source of income in two-thirds of the
surveyed units. Own microbiology laboratory was not available for 26.8% of
the surveyed intensive care units, and 10.5% did not always have access to
blood cultures. Broad spectrum antibiotics were not always available in
10.5% of surveyed units, and 21.3% could not always measure lactate within
three hours. Those institutions with a high resource availability (158
units, 57%) were usually larger and preferentially served patients from the
private health system compared to institutions without high resource
availability. Otherwise, those without high resource availability did not
always have broad-spectrum antibiotics (24.4%), vasopressors (4.2%) or
crystalloids (7.6%).
Conclusion
Our study indicates that a relevant number of units cannot perform basic
monitoring and therapeutic interventions in septic patients. Our results
highlight major opportunities for improvement to adhere to simple but
effective interventions in Brazil.
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