Planning and understanding the intensive care network in the State of Rio de Janeiro (RJ), Brazil: a complex societal problem

Abstract

ObjectivesTo determine the optimal number of adult intensive care unit beds to reduce patient's queue waiting time and to propose policy strategies.MethodsMultimethodological approach: (a) quantitative time series and queueing theory were used to predict the demand and estimate intensive care unit beds in different scenarios; (b) qualitative focus group and content analysis were used to explore physicians' attitudes and provide insights into their behaviors and belief-driven healthcare delivery changes.ResultsA total of 33,101 requests for 268 regulated intensive care unit beds in one year resulted in 25% admissions, 55% queue abandonment and 20% deaths. Maintaining current intensive care unit arrival and exit rates, there would need 628 beds to ensure a maximum wait time of six hours. A reduction of the current abandonment rates due to clinical improvement or the average intensive care unit length of stay would decrease the number of beds to 471 and 366, respectively. If both were reduced, the number would reach 275 beds. The interviews generated 3 main themes: (1) the doctor's conflict: fair, legal, ethical and shared priorities in the decision-making process; (2) a failure of access: invisible queues and a lack of infrastructure; and (3) societal drama: deterioration of public policies and health care networks.ConclusionThe queue should be treated as a complex societal problem with a multifactorial origin requiring integrated solutions. Improving intensive care unit protocols and reengineering the general wards may decrease the length of stay. It is essential to redefine and consolidate the regulatory centers to organize the queue and provide available resources in a timely manner, by using priority criteria, working with stakeholders to guarantee clinical governance and network organization.

Factors associated with readmissions to an adult intensive care unit at a university hospital

“…Neste estudo, observou-se que não havia planos e/ou protocolos de alta descritos no prontuário eletrônico dos pacientes, o que talvez favoreça a ocorrência de altas precoces. O planejamento de alta da Unidade de Terapia Intensiva deve iniciar na admissão do paciente e, para tanto, recomenda-se a elaboração racional e o uso de protocolos para reduzir o tempo de permanência no setor crítico, uma vez que a disponibilidade de leitos é desproporcional à demanda de necessidade (15) . Alvitra-se, no entanto, que além de buscar tempo menor de permanência em Unidade de Terapia Intensiva, o uso destes meios e os instrumentos de gerenciamento do cuidado crítico também devem viabilizar o planejamento da alta segura, de forma multidisciplinar.…”

Ethical dilemmas in COVID-19 times: how to decide who lives and who dies?

“…In this context, some authors have reported that the problem of hospital infrastructure with limited access is old and remains true in many regions. Goldwasser et al 6 , for example, relate a small number of units and demand, which generates a gap between availability and the admission flow. In short, the authors have reported that the system defends universal care, but there is no room for everyone.…”

“…There is a gap between availability and the demand for ICU beds. In addition to the inadequate infrastructure, there is also an absence of protocols and a lack of trained human resources [6][7][8] .…”

Access to public health services and integral care for women during the puerperal gravid period period in Ceará, Brazil

“…The waiting time for a woman to receive healthcare plays an important role during puerperal pregnancy, on the health of pregnant women, mothers and newborns [11]. Research indicates that a waiting period of up to 6 h is considered clinically feasible to keep the prognosis unchanged [12, 13].…”