Cross sectional study of structural quality of German intensive care units. A reevaluation of the DIVI register

• Published in: Medizinische Klinik, Intensivmedizin und Notfallmedizin Vol. 108; no. 6; pp. 497 - 506
• Main Authors: Fölsch, C, Kofahl, N, Waydhas, C, Stiletto, R
• Format: Journal Article
• Language: German
• Published: Germany 01-09-2013
• Subjects: Costs and Cost Analysis; Germany; Historically Controlled Study; Humans; Intensive Care Units - economics; Intensive Care Units - organization & administration; Intensive Care Units - standards; Intermediate Care Facilities - economics; Intermediate Care Facilities - organization & administration; Intermediate Care Facilities - standards; National Health Programs - economics; Patient Care Team - economics; Patient Care Team - organization & administration; Patient Care Team - standards; Quality Assurance, Health Care - economics; Quality Improvement - economics; Quality Improvement - organization & administration; Quality Improvement - standards; Registries; Respiration, Artificial - economics; Respiration, Artificial - standards; Germany
• ISSN: 2193-6226
• DOI: 10.1007/s00063-013-0251-1

Effectiveness of intensive care treatment is essential to cope with increasing costs. The German national register of intensive care established by the German Interdisciplinary Association for Intensive Care Medicine (DIVI) contains basic data on the structure of intensive care units in Germany. A repeat analysis of data of the DIVI register within 8 years provides information for the development of intensive care units under different economic circumstances.
The recent data on the structure of intensive care units were obtained in 2008 and compared with the primary multicenter study from 2000. The hospitals selected were a representative sample for the whole of Germany. Data on the status of the hospital, staff and technical facilities, foundation of the hospital and the statistics of mechanically ventilated patients were analyzed.
The technical facilities and the number of staff have improved from 2000 to 2008. A smaller availability of diagnostic procedures and staff remain in hospitals for basic treatment outside normal working hours. The average utilization of intensive care unit beds was not altered. The existence of intermediate care units did not significantly change the proportion of patients with artificial ventilation or ventilation times. The number of beds in intensive care units was unchanged as was the average number of beds in units and the number of patients treated. A relevant number of beds of intensive care units shifted towards hospitals with private foundation without changes in the overall numbers. The structure of the hospitals was comparable at both time points.
The introduction of intermediate care units did not alter ventilation parameters of patients in 2008 compared with 2000. There is no obvious medical reason for the shift of intensive care beds towards private hospitals. The number of staff and patients varied considerably between the intensive care units. The average number of patients treated per bed was not different between the periods or between hospitals with different structures. Overall availability of medical staff and diagnostic procedures increased during the study period. An increase of availability of fully trained medical staff in intensive care medicine is desirable to increase the quality of treatment.