Effects of Organizational Characteristics on Outcomes and Resource Use in Patients With Cancer Admitted to Intensive Care Units

Abstract

Organizational aspects, namely the implementation of protocols and presence of clinical pharmacists in the ICU, and close collaboration between oncologists and ICU teams are targets to improve mortality and resource use in critically ill patients with cancer.

Do hospitals need oncological critical care units?

“…Of those, 51 were in general hospitals and 19 were in cancer centers. The authors found that the presence of clinical pharmacists in the ICU, presence of ICU protocols, and daily meetings between oncologists and intensivists were associated with lower hospital mortality even after adjustment for hospital case volume (21). Protocols and daily meetings were also associated with more efficient resource utilization.…”

“…The use of protocols co-developed by oncologists and intensivists may be the way to bridge the knowledge gap between medical specialties and improve outcomes for cancer patients in a general ICU while utilizing an existing infrastructure of high intensity staffing. Soares et al did not see improved outcomes with cancer specific protocols (21). Perhaps this is due to the number of or the specific protocols used.…”

“…In a recent issue of the Journal of Clinical Oncology, Soares et al described how ICU organizational characteristics might affect clinical outcomes and resource utilization in patients with cancer (21). In ORCHESTRA, the authors retrospectively reviewed 9,946 patients admitted to 70 ICUs in Brazil.…”

Focus on immunocompromised patients

“…After demonstrating organizational factors associated with improved outcome in critically ill cancer patients (namely presence of clinical pharmacist, daily meeting with oncologist and implemented clinical protocols) [1], Soares et al demonstrated an association between liberal visiting policies for family members and implemented processes to improve communication with families in units with higher performance as assessed by standardized mortality ratio or resource use as assessed by standardized resource use [14].…”

“…In this context, immunocompromised patients are a special population requiring specific knowledge, management and attention from the staff. Immunocompromised patients are being increasingly admitted to intensive care units (ICU), requiring complex and ideally multidisciplinary management [1]. Here, we summarize the most important recently published papers in this field.…”