Clinical performance and resource utilisation of a respiratory intensive care unit. Analysis of five years of clinical activity | Revista Médica del Hospital General de México

array:24 ["pii" => "S018510631630049X" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2016.05.019" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "96" "copyright" => "Sociedad Médica del Hospital General de México" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Med Hosp Gen Mex. 2016;79:144-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1189 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 835 "PDF" => 312 ] ] "itemSiguiente" => array:19 [ "pii" => "S0185106316300117" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2016.04.001" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "70" "copyright" => "Sociedad Médica del Hospital General de México" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Med Hosp Gen Mex. 2016;79:150-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1679 "formatos" => array:3 [ "EPUB" => 58 "HTML" => 1127 "PDF" => 494 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Hepatitis E virus incidence in patients with non-identified acute viral hepatitis in Mexico" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "150" "paginaFinal" => "154" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia del Virus de Hepatitis E en pacientes con hepatitis viral aguda no identificada en México" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1956 "Ancho" => 2666 "Tamanyo" => 252391 ] ] "descripcion" => array:1 [ "en" => "Areas and regions in Mexico where HEV cases were found. These areas are marked with different colors. The region marked in blue is the area where most of the cases occurred, the region marked in red is the 2nd and the region marked in yellow is where the least cases were found." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Berebichez-Fridman, R. Vázquez-Campuzano, J.A. Galnares-Olalde, R. Blachman-Braun" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Berebichez-Fridman" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Vázquez-Campuzano" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Galnares-Olalde" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Blachman-Braun" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106316300117?idApp=UINPBA00004N" "url" => "/01851063/0000007900000003/v1_201608260031/S0185106316300117/v1_201608260031/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0185106316300518" "issn" => "01851063" "doi" => "10.1016/j.hgmx.2016.05.021" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "98" "copyright" => "Sociedad Médica del Hospital General de México" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Med Hosp Gen Mex. 2016;79:136-43" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1534 "formatos" => array:3 [ "EPUB" => 59 "HTML" => 1172 "PDF" => 303 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Prevalence of sleep disorders, daytime sleepiness and clinical symptomatology in older adults" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "136" "paginaFinal" => "143" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de trastornos de sueño, somnolencia diurna y sintomatología clínica en adultos mayores" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 801 "Ancho" => 1605 "Tamanyo" => 47646 ] ] "descripcion" => array:1 [ "en" => "Sleep architecture of the elderly patients." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.Á. Mendoza-Meléndez, U. Jimenez-Correa, A. Gallegos-Cari, F. Ayala-Guerrero, A. Jiménez-Anguiano" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M.Á." "apellidos" => "Mendoza-Meléndez" ] 1 => array:2 [ "nombre" => "U." "apellidos" => "Jimenez-Correa" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Gallegos-Cari" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Ayala-Guerrero" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Jiménez-Anguiano" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106316300518?idApp=UINPBA00004N" "url" => "/01851063/0000007900000003/v1_201608260031/S0185106316300518/v1_201608260031/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Clinical performance and resource utilisation of a respiratory intensive care unit. Analysis of five years of clinical activity" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "144" "paginaFinal" => "149" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Álvarez-Maldonado, A. Pérez-Rosales, G. Cueto-Robledo, U. Cerón-Díaz, C. Núñez-Pérez-Redondo, F. Navarro-Reynoso, R. Cicero-Sabido" "autores" => array:7 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Álvarez-Maldonado" "email" => array:1 [ 0 => "pamyacs@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Pérez-Rosales" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Cueto-Robledo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "U." "apellidos" => "Cerón-Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "C." "apellidos" => "Núñez-Pérez-Redondo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "F." "apellidos" => "Navarro-Reynoso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "R." "apellidos" => "Cicero-Sabido" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Pulmonology and Thoracic Surgery, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Head of the ICU, Hospital Ángeles Lindavista and Hospital Ángeles Acoxpa, Assigned to the ICU, Hospital Español de México, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "School of Medicine, UNAM, Mexico City, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Servicio de Neumología y Cirugía de Tórax, Hospital General de México “Dr. Eduardo Liceaga”, c. Dr. Balmis 148, C.P. 06726 Mexico City, Mexico." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rendimiento clínico y uso de recursos de una unidad de cuidados intensivos respiratorios. Análisis de cinco años de actividad asistencial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1212 "Ancho" => 1635 "Tamanyo" => 95648 ] ] "descripcion" => array:1 [ "en" => "Revised Rapoport–Teres method graph for intensive care units graduated in standard deviations [SD]. Coordinates within ±2 SD indicate that the performance of an ICU is consistent with that of its peers, units in Project IMPACT considered “standard” against which it is compared." ] ] ] "textoCompleto" => "BackgroundImproving intensive care unit performance is a primary goal in quality of care management. To achieve this improvement, measuring with tools that enable us to make comparisons with proposed standards is necessary. One tool currently used by intensive care units in North America, more specifically in the United States and in some Mexican units is the Rapoport–Teres method.<a class="elsevierStyleCrossRef" href="#bib0105">1</a> This method, which plots clinical performance and costs on two axes using relatively easy to obtain information and is not very complex to interpret visually, was initially described in 1994.<a class="elsevierStyleCrossRef" href="#bib0110">2</a> Since then it has been used by intensive care units in Project IMPACT, a multi-centre database in the U.S.<a class="elsevierStyleCrossRef" href="#bib0115">3</a> In 2007, the method was recalibrated to adjust it to more contemporary clinical results and resource utilisation without sacrificing too much of its simplicity.<a class="elsevierStyleCrossRef" href="#bib0120">4</a> The expected benefit of performing this type of analysis includes, among others, comparing the performance results of one unit with other intensive care units considered to be “standard”, so that, should sub-standard performance results be obtained, the care model of high-performance units can be copied (care, protocols, supplies, etc.), or, should a satisfactory result be obtained, the current strategies and care model can continue to be used. The analysis also enables clinical performance and resource utilisation to be compared for the same unit in different periods, to be able to describe the changes and possible phenomena related to those changes. The objective of this study is to describe and analyse the clinical performance and resource utilisation of the respiratory intensive care unit (RICU) of a public hospital over a 5-year period (March 2010–March 2015).MethodsType of studyCross-sectional, comparative, retrospective study.Patients and siteAll patients admitted to the RICU belonging to the Department of Pulmonology and Thoracic Surgery at the “Dr. Eduardo Liceaga” General Hospital of Mexico, a public teaching hospital with 901 beds, during the period from 1 March 2010 to 1 March 2015 were included. Readmissions and patients under 18 years old were excluded from the analysis. The RICU is one of eight intensive care units within the General Hospital of Mexico and it has seven beds. The RICU has a multidisciplinary team that includes a certified critical care physician and pulmonologist during the morning shift, as well as pulmonology residents, rotating internal medicine residents in the morning, afternoon, and night shifts supported by a certified pulmonologist in charge of the Department. The nurse–patient ratio is from 1:1 to 1:3 while the ratio of nurse specialising in critical care medicine to patients is from 1:3 to 1:7. The RICU also has respiratory therapists during the morning shifts and on weekends.Source of dataAll data for the analysis were taken from the DeDUCIR (Deposito de Datos de la UCIR [RICU Data Deposit]) database. This Excel database was implemented in 2010 and was based on the local BASUTI database<a class="elsevierStyleCrossRef" href="#bib0125">5</a> and the multi-centre intensive care unit BDM-TI database.<a class="elsevierStyleCrossRef" href="#bib0130">6</a> It includes data on demographics, severity and prognosis, time on mechanical ventilation, stay in the hospital and ICU, mortality, procedures, and complications, among others.Revised Rapoport–Teres methodRapoport proposed a two-dimensional method that plots clinical performance (standardised clinical performance index=SCPI) and cost-effectiveness (standardised resource utilisation index=SRUI) onto two axes, which are calculated according to the adjusted 2007 model<a class="elsevierStyleCrossRef" href="#bib0120">4</a> as follows:SCPI (x-axis): to obtain the standardised clinical performance index, first the difference in survival (ΔSurvival) of the study population is obtained by subtracting expected survival from observed survival as follows:<elsevierMultimedia ident="eq0005"></elsevierMultimedia>To adjust this difference, the mean difference in survival (0.110) was extracted and divided by the standard deviation of the difference in survival (4.668) obtained from the group of patients from the adjusted Rapoport model. The result is the x-axis value or SCPI.SRUI (y-axis): to obtain the standardised resource utilisation index a value was assigned to the days of stay in the ICU and to the post-ICU days for each patient. The highest value is given to the first day in the ICU (4 points), a value of 2.5 points for each subsequent day in the ICU, and one point to the post-ICU days. A mean value of the points obtained from all the patients is called “weighted hospital days” (WHD). Based on a linear regression analysis in the revised Rapoport model, a need was seen to submit the WHD value to a logarithmic equation (base 10) to obtained the “expected weighted hospital days” (WHDe), which in addition to including the mortality of the study population, includes independent variables that were identified as predictive of ICU outcome as detailed below:<elsevierMultimedia ident="eq0010"></elsevierMultimedia>Afterwards, the difference in hospital days was obtained by subtracting the expected weighted hospital days from the actual weighted hospital days:<elsevierMultimedia ident="eq0015"></elsevierMultimedia>The mean ΔWHD (−0.232) was subtracted from this difference and was divided by the ΔWHD standard deviation (3.786) obtained from the group of patients from the adjusted Rapoport model. The result is the y-axis value, or SRUI.For visual interpretation purposes, the SCPI and SRUI values are plotted on a four-quadrant coordinate graph designed for this purpose that enables the results to be compared with those obtained by other units participating in Project IMPACT in the U.S. (in standard deviations, SD). Coordinates in upper right quadrant, that is where SCPI and SRUI values are greater than zero, indicate better survival and lower resource utilisation that expected, while negative values for these indices indicate that mortality and resource utilisation are higher than expected.ResultsIn a 5-year study period, 1177 patients were admitted to the RICU. Readmissions (n=34) and patients <18 years old (n=7) were excluded from the analysis. In 1136 patients, the actual survival rate was 55% and the survival rate predicted by SAPS-3 (simplified acute physiology score) was 74%. Characteristics of the included patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Of the patients who did not survive, 18% died within the first 48h of their stay in the RICU and 8.4% died within the first 24h of their stay. The variables for calculating the SCPI and SRUI and the outcomes by period are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The fraction of patients admitted for non-scheduled surgery, patients on invasive mechanical ventilation, and discharged to another hospital were included in the formula to calculate the SRUI. Being discharged to another hospital was the only criterion (from a series using the revised Rapoport method) that applied for the study population according to the criteria considered to be a discharge to a post-acute care unit. The SCPI for all patients was −4.0 (x-axis) and the SRUI was 0.94 (y-axis). This places the overall performance in the upper left quadrant (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>DiscussionThe expenses an ICU generates can account for up to one third of the expenses generated by a hospital.<a class="elsevierStyleCrossRef" href="#bib0135">7</a> The most ill patients, moreover, will be more likely to die in intensive care units in comparison with other areas during their hospital stay. Both aspects make ICU spaces complex to administer, either in managing resources or strategies that seek to improve their clinical outcomes.As for other areas of a hospital, there are many ways for the ICU to evaluate the cost of healthcare interventions and its impact on the outcomes obtained.<a class="elsevierStyleCrossRefs" href="#bib0105">1,8–10</a> Given the diversity of methods and the complexity of defining the cost derived from the change in the health of an individual or group of individuals with different conditions, or even more, defining the monetary value of a life, often times the rationale for making these measurements is to self-assess the performance of an ICU over time. One example of a practical tool that has been successful due to its simplicity for measuring the performance of an ICU is the Rapoport method which combines clinical assessment (SCPI) with financial measurements (SRUI), enabling where improvements are required to be identified and graphically comparing performance with other ICUs.Although the resource utilisation index in the RICU (SRUI) is within an acceptable parameter (±2 SD, which is consistent with the average performance of its peers, i.e. 135 ICUs participating in Project IMPACT), its clinical performance is below standard. The costs alone give us an incomplete view of the overall performance of an ICU since units with sub-standard care can have lower resource utilisation and an inappropriately high mortality.<a class="elsevierStyleCrossRef" href="#bib0120">4</a> Furthermore, resources in an ICU may be scarce or absent, which results in a deficient clinical performance. Resources should not be understood simply as supplies, since an ICU encompasses a structure, with a physical area, equipment (which includes supplies), and staff (human team), and the ways in which the staff carry out their actions (processes).Yet the analysis conducted when adjusting the Rapoport method in 2007 did not find a significant correlation between costs and mortality (which means that an excessive use of resources is not necessary associated with exceptional clinical performance or vice versa), in the particular case of the RICU a trend has been observed that clinical performance improves when more resources are used, which could suggest that identifying areas of opportunity to inject resources may result in benefits.Unlike the care models of units with good performance from Project IMPACT and Mexican units that have reported their results using the Rapoport method,<a class="elsevierStyleCrossRefs" href="#bib0130">6,11,12</a> the RICU does not have critical care physicians available for care 24/7. In addition, the ratio of nursing staff and respiratory therapists who are part of the RICU multi-disciplinary team is deficient. Making sure healthcare staff resources coincide with patient needs is a key factor for quality of care in the ICU. Patient safety is put at risk when the patient:healthcare staff ratio exceeds certain limits and when the workload is excessive.<a class="elsevierStyleCrossRef" href="#bib0165">13</a>Strategic planning, on the other hand, is essential for care in the intensive care unit to prosper, providing good patient care and enabling an efficient use of resources.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> The RICU has implemented its own quality of care management systems which have merited recognition in the international scientific media,<a class="elsevierStyleCrossRefs" href="#bib0175">15,16</a> a mid-term work plan (2014–2017), and a long-term vision. This suggests to us that the on-going efforts to improve care are present with strategies that are applied in high-performing units in Mexico and the United States. The RICU is currently implementing the strategies from the Bacteremia Zero<a class="elsevierStyleCrossRef" href="#bib0185">17</a> and Pneumonia Zero<a class="elsevierStyleCrossRef" href="#bib0190">18</a> projects, which have demonstrated excellent results in Europe and the U.S.,<a class="elsevierStyleCrossRef" href="#bib0195">19</a> in addition to implementing a hand hygiene adherence program that promotes a culture of quality. The opportunities for improvement by implementing strategies that do not require large investments or complex technology are innumerable and the RICU is not ignorant of these efforts, which also include collaborations with similar units in Mexico.<a class="elsevierStyleCrossRef" href="#bib0200">20</a> Moreover, in 2017 the RICU and the Department of Pulmonology are expected to move into a new physical area, a building to care for patients with cardiopulmonary conditions which is planned to have facilities with a design and equipment that are adapted to the current standards.There are some limitations to the presented analysis which deserve mention. First, to calculate the SCPI and SRUI the expected survival according to the SAPS-3 prediction model was used, and not that according to the MPM0-III model as in the revised Rapoport method. It must be taken into account that the tool was only validated for the latter model. Even if the study population were eligible for the MPM model, the RICU has a unique population of patients with predominantly respiratory conditions (medical and surgical), in which the model calibrated for WHD could be inadequate. Second, nearly one fifth of the patients who died in the RICU did so within the first 48h of their stay, which makes us think that patients who are too critically ill are admitted and that SAPS-3 may overestimate the expected survival (like other models). In that case, it would require a local validation of the prediction model to adjust it to the patient population cared for. Third, due to not knowing the proportion of patients who required mechanical ventilation in the first hour of admission to the RICU, the total proportion of patients on mechanical ventilation was used to calculate the SRUI. However, this aspect makes it so that SRUI is underestimated. Fourth, when the Rapoport method was adjusted in 2007, some speculations were proposed to explain why better survival was observed in the ICUs at that time compared with the original method 13 years earlier in 1994,<a class="elsevierStyleCrossRef" href="#bib0120">4</a> for example, the greater role of 24-h critical care physicians, the intervention of multidisciplinary teams in medical rounds, the implementation of a series of measures to improve the quality of care, and the pharmaceutical and technological advances, among others. These speculations may play a role 8 years after the last calibration of the Rapoport method. That is, a new calibration may now be necessary. Lastly, the results of the RICU performance cannot be compared with those obtained by other Mexican ICUs since the units that reported their analysis with the method did so before it had been calibrated [before 2007].ConclusionsAlthough the resource utilisation index in the RICU is within an acceptable parameter, a clinical performance below the standard is observed. Copying the care model of ICUs with good performance could be beneficial for the RICU to improve its performance. As the RICU has improvement programs in its protocols and processes, it mainly needs to copy aspects of the care model of other ICUs with good performance. Hiring specialised, multi-disciplinary staff for shifts, improving its physical structure and equipment, and reinforcing its processes, among others, are areas of opportunity.Ethical disclosureProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this investigation.Confidentiality of dataThe authors declare that no patient data appear in this article.Right to privacy and informed consentThe authors declare that no patient data appear in this article.FundingNone.Conflict of interestThe authors declare they have no conflicts of interest related to the preparation of this manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres721839" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec726906" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres721840" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedente" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec726907" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Type of study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patients and site" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Source of data" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Revised Rapoport–Teres method" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:3 [ "identificador" => "sec0050" "titulo" => "Ethical disclosure" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "xack239832" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-08-22" "fechaAceptado" => "2016-05-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec726906" "palabras" => array:5 [ 0 => "Clinical performance" 1 => "Cost-effectiveness" 2 => "Resource utilisation" 3 => "Quality management" 4 => "Intensive care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec726907" "palabras" => array:5 [ 0 => "Rendimiento clínico" 1 => "Costo-efectividad" 2 => "Uso de recursos" 3 => "Gestión de calidad" 4 => "Terapia intensiva" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundImproving intensive care unit (ICU) performance is a primary goal in quality of care management; for this purpose, measuring with tools that enable us to make comparisons with proposed standards is necessary. ObjectiveTo describe the clinical performance and resource utilisation of a respiratory ICU (RICU) over a 5-year period. Material and methodsA cross-sectional, retrospective, comparative study was conducted in the RICU of a teaching hospital. Using the revised Rapoport–Teres method, the standardised clinical performance index (SCPI) and the standardised resource utilisation index (SRUI) were calculated annually and for the entire study period. The results were compared with those obtained by the ICUs participating in Project IMPACT (in standard deviations) in a four-quadrant coordinate graph designed for this purpose. SCPI and SRUI values greater than zero indicate better survival and a lower resource utilisation than expected. Values below zero indicate a mortality and resource utilisation higher than expected. ResultsIn the study period, 1177 patients were admitted to the RICU. Readmissions (n=34) and patients <18 years old (n=7) were excluded from the analysis. In 1136 patients, the observed survival rate was 55% and the survival rate predicted by SAPS-3 (simplified acute physiology score) was 74%. The fraction of unscheduled surgery patients, those receiving invasive mechanical ventilation, and those discharged to another hospital were included in the SRUI calculation. The SCPI and the SRUI for the entire study period were −4.0 and 0.94 respectively. ConclusionAlthough the resource utilisation index in the RICU is within an acceptable parameter, a clinical performance below the standard is observed. Copying the care model of ICUs with good performance could be beneficial for the RICU to improve its performance." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Material and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedenteMejorar el rendimiento de la unidad de cuidados intensivos (UCI) es un objetivo primordial en la gestión de calidad, para esto, es necesario medir con herramientas que nos permitan hacer comparaciones con estándares propuestos. ObjetivoDescribir el rendimiento clínico y uso de recursos de una UCI respiratoria (UCIR) en 5 años. Material y MétodosEstudio transversal retrospectivo comparativo en la UCIR de un hospital público escuela. Utilizando el método revisado de Rapoport–Teres se hizo el cálculo del índice de rendimiento clínico estandarizado (IRCE) y del índice de uso de recursos estandarizado (IURE) de manera global y por periodos de un año comparando los resultados con los obtenidos por las UCIs participantes del proyecto IMPACT (en desviaciones estándar) en un gráfico de coordenadas de cuatro cuadrantes diseñado para este propósito. Valores de IRCE e IURE mayores a cero indican mejor sobrevida y menor uso de recursos que los esperados. Valores menores a cero indican una mortalidad y uso de recursos mayores a los esperados. ResultadosEn el periodo de estudio ingresaron a la UCIR 1177 pacientes, fueron excluidos para el análisis los re-ingresos (n=34) y los <18 años (n=7). En 1136 pacientes la sobrevida actual fue de 55%, la sobrevida predicha por SAPS-3 (simplified acute physiology score) fue de 74%. Para el cálculo del IURE fueron incluidos en la formula la fracción de pacientes ingresados por cirugía no programada, pacientes en ventilación mecánica invasiva y los egresados a otro hospital. El IRCE para todo el periodo de estudio fue de −4.0 y el IURE de 0.94. ConclusiónAunque el índice de uso de recursos de la UCIR está en un parámetro aceptable, se observa un rendimiento clínico por debajo del estándar. Copiar el modelo de unidades con buen rendimiento podría resultar de beneficio para mejorar el desempeño de la UCIR." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Antecedente" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1212 "Ancho" => 1635 "Tamanyo" => 95648 ] ] "descripcion" => array:1 [ "en" => "Revised Rapoport–Teres method graph for intensive care units graduated in standard deviations [SD]. Coordinates within ±2 SD indicate that the performance of an ICU is consistent with that of its peers, units in Project IMPACT considered “standard” against which it is compared." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD, standard deviation; SAPS-3, simplified acute physiology score 3; SOFA, sequential organ failure assessment; ICU, intensive care unit." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=1136 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48±17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex, male/female [%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">592/544 [52/48] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SAPS-3±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51±19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SOFA±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.2±4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Invasive mechanical ventilation, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Origin</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonology hospitalisation ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">321 [28.3] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency department \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">247 [21.7] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pulmonology operating room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">241 [21.2] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other hospitalisation ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">149 [13.1] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Operating room in other departments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">116 [10.2] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other ICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 [2.9] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outpatient pulmonology appointment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 [1.7] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 [0.9] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Reason for admission to the ICU</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">523 [46.0] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Post-operative [elective or non-elective] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">375 [33.0] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">180 [15.8] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 [3.3] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 [1.1] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metabolic failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 [0.4] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haematological failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 [0.1] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liver failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 [0.1] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1186604.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the patients included." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SCPI, standardised clinical performance index; SRUI, standardised resource utilisation index; SAPS-3, simplified acute physiology score; WHD, weighted hospital days." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period [March–March] \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2010–11 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2011–12 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2012–13 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2013–14 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2014–15 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total 5 years \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total patients in the period \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">226 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">236 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">230 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">196 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1177 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total patients without readmissions, without patients <18 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">272 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">221 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1136 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actual survival [real] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Expected survival per SAPS-3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.739 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.736 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.748 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.745 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difference in survival [ΔSurvival] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−19.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−23.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−20.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−18.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−18.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SCPI [x-axis] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−5.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−4.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">% Unscheduled surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.138 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">% Mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">% Discharged to external acute care \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actual weighted hospital days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Predicted weighted hospital days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.92 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difference in hospital days [ΔWHD] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−3.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SRUI [y-axis] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1186603.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Variables for calculating the SCPI and SRUI and outcomes by period." ] ] 3 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "ΔSurvival=(actual   survival−expected   survival)×100" "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 3289 "Alto" => 14 "Ancho" => 376 ] ] 4 => array:5 [ "identificador" => "eq0010" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Log10(WHD)=1.008+0.753×(%   in-hospital   deaths)+0.432×(%   unscheduled   surgery)+0.228×(%   mechanical   ventilation   within   1   h   of   admission   to   the   ICU)−0.708×(%   patients   discharged   to   post-acute   care   outside   the   hospital)" "Fichero" => "STRIPIN_si2.jpeg" "Tamanyo" => 14604 "Alto" => 152 "Ancho" => 390 ] ] 5 => array:5 [ "identificador" => "eq0015" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "ΔWHD=WHD−WHDe" "Fichero" => "STRIPIN_si3.jpeg" "Tamanyo" => 1343 "Alto" => 11 "Ancho" => 151 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calidad y costo-efectividad en la atención del paciente crítico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.A. Elguea Echavarría" 1 => "U.W. Cerón Díaz" 2 => "J.G. Esponda Prado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int" "fecha" => "2012" "volumen" => "26" "paginaInicial" => "42" "paginaFinal" => "50" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Rapoport" 1 => "D. Teres" 2 => "S. Lemeshow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1994" "volumen" => "22" "paginaInicial" => "1385" "paginaFinal" => "1391" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8062559" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Project IMPACT: results from a pilot validity study of a new observational database" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Project IMPACT Clinical Implementation Committee" "etal" => true "autores" => array:3 [ 0 => "S.F. Cook" 1 => "W.A. Visscher" 2 => "C.L. Hobbs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000039570.92750.7A" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2002" "volumen" => "30" "paginaInicial" => "2765" "paginaFinal" => "2770" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12483071" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A revised method to assess intensive care unit clinical performance and resource utilization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.H. Nathanson" 1 => "T.L. Higgins" 2 => "D. Teres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.CCM.0000275272.57237.53" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2007" "volumen" => "35" "paginaInicial" => "1853" "paginaFinal" => "1862" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17568328" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Base de datos para el control de calidad y utilización de recursos en la Unidad de Terapia Intensiva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "U. Cerón" 1 => "A. Sierra" 2 => "R. Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int" "fecha" => "1996" "volumen" => "10" "paginaInicial" => "105" "paginaFinal" => "201" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rendimiento clínico y costo-efectividad de tres unidades de terapia intensiva mexicanas incluidas en la base de datos multicéntrica de terapia intensiva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "U.W. Cerón Díaz" 1 => "J. Esponda Prado" 2 => "M. Borbolla Paya" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int" "fecha" => "2000" "volumen" => "14" "paginaInicial" => "41" "paginaFinal" => "49" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An update on cost-effectiveness analysis in critical care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.F. Shorr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Opin Crit Care" "fecha" => "2002" "volumen" => "8" "paginaInicial" => "337" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12386495" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Costo efectividad de la atención en cuidados intensivos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.J. Villagómez Ortiz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int" "fecha" => "2012" "volumen" => "4" "paginaInicial" => "192" "paginaFinal" => "193" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is critical care ready for an economic surrogate endpoint?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.E. Wilcox" 1 => "G.D. Rubenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-015-0947-0" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2015" "volumen" => "19" "paginaInicial" => "248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26067467" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care performance: how should we monitor performance in the future?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.K. Timmers" 1 => "M.H. Verhofstad" 2 => "K.G. Moons" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5492/wjccm.v3.i4.74" "Revista" => array:6 [ "tituloSerie" => "World J Crit Care Med" "fecha" => "2014" "volumen" => "3" "paginaInicial" => "74" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25374803" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de costo-efectividad por el método de Rapoport en un año de actividad asistencial en una unidad de terapia intensiva polivalente privada en México" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Abascal Caloca" 1 => "U.W. Cerón Díaz" 2 => "J.P. Vázquez Mathieu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int" "fecha" => "2006" "volumen" => "1" "paginaInicial" => "5" "paginaFinal" => "11" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparación del rendimiento clínico y costo-efectividad en tres periodos durante nueve años de actividad asistencial de una unidad de terapia intensiva" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "U.W. Cerón Díaz" 1 => "C. Abascal" 2 => "A. Sierra Unzueta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int" "fecha" => "2006" "volumen" => "20" "paginaInicial" => "126" "paginaFinal" => "135" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Patient mortality is associated with staff resources and workload in the ICU: a multicenter observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Neuraz" 1 => "C. Guérin" 2 => "C. Payet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000001015" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2015" "volumen" => "43" "paginaInicial" => "1587" "paginaFinal" => "1594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25867907" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guide to strategic planning in critical care medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Kyeremanteng" 1 => "G. D’Egidio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hosp Admin" "fecha" => "2015" "volumen" => "3" "paginaInicial" => "93" "paginaFinal" => "96" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cambios en tres indicadores de calidad después de la implementación de estrategias de mejora en la unidad de cuidados intensivos respiratorios" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Álvarez Maldonado" 1 => "G. Cueto Robledo" 2 => "R. Cicero Sabido" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2014.01.006" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "142" "paginaFinal" => "148" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24661920" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measuring the quality of intensive care medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.C. Martín-Delgado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2014.04.006" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "1" "paginaFinal" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24951246" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0185" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "<a id="intr0005" class="elsevierStyleInterRef" href="http://www.semicyuc.org/temas/calidad/bacteriemia-zero">http://www.semicyuc.org/temas/calidad/bacteriemia-zero</a> [accessed 1.07.15]" ] ] ] 17 => array:3 [ "identificador" => "bib0190" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "<a id="intr0010" class="elsevierStyleInterRef" href="http://www.semicyuc.org/temas/investigacion/proyectos-de-la-semicyuc/neumonia-zero">http://www.semicyuc.org/temas/investigacion/proyectos-de-la-semicyuc/neumonia-zero</a> [accessed 1.07.15]" ] ] ] 18 => array:3 [ "identificador" => "bib0195" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Palomar" 1 => "F. Álvarez-Lerma" 2 => "A. Riera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3182923622" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "2364" "paginaFinal" => "2372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23939352" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0200" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Task force for the review, modification and development of quality indicators for respiratory intensive care units in Mexico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Álvarez-Maldonado" 1 => "E. Bautista-Bautista" 2 => "V. Huizar-Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2013.12.009" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2015" "volumen" => "51" "paginaInicial" => "357" "paginaFinal" => "358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25278215" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack239832" "titulo" => "Acknowledgements" "texto" => "Thank you to the nurses, residents, pulmonologists, and respiratory therapists who provide their valuable service in the Respiratory Intensive Care Unit at the General Hospital of Mexico." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/01851063/0000007900000003/v1_201608260031/S018510631630049X/v1_201608260031/en/main.assets" "Apartado" => array:4 [ "identificador" => "40782" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/01851063/0000007900000003/v1_201608260031/S018510631630049X/v1_201608260031/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S018510631630049X?idApp=UINPBA00004N"]

Statistics

Original Article

Clinical performance and resource utilisation of a respiratory intensive care unit. Analysis of five years of clinical activity

Rendimiento clínico y uso de recursos de una unidad de cuidados intensivos respiratorios. Análisis de cinco años de actividad asistencial

P. Álvarez-Maldonadoa,

Corresponding author

pamyacs@yahoo.com

Corresponding author at: Servicio de Neumología y Cirugía de Tórax, Hospital General de México “Dr. Eduardo Liceaga”, c. Dr. Balmis 148, C.P. 06726 Mexico City, Mexico.

, A. Pérez-Rosalesa, G. Cueto-Robledoa, U. Cerón-Díazb, C. Núñez-Pérez-Redondoa, F. Navarro-Reynosoa, R. Cicero-Sabidoa,c

a Department of Pulmonology and Thoracic Surgery, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico

b Head of the ICU, Hospital Ángeles Lindavista and Hospital Ángeles Acoxpa, Assigned to the ICU, Hospital Español de México, Mexico City, Mexico

c School of Medicine, UNAM, Mexico City, Mexico

Read

2712

Times
was read the article

715

Total PDF

1997

Total HTML

Share statistics

 array:24 [
  "pii" => "S018510631630049X"
  "issn" => "01851063"
  "doi" => "10.1016/j.hgmx.2016.05.019"
  "estado" => "S300"
  "fechaPublicacion" => "2016-07-01"
  "aid" => "96"
  "copyright" => "Sociedad M&#233;dica del Hospital General de M&#233;xico"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Med Hosp Gen Mex. 2016;79:144-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1189
    "formatos" => array:3 [
      "EPUB" => 42
      "HTML" => 835
      "PDF" => 312
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0185106316300117"
    "issn" => "01851063"
    "doi" => "10.1016/j.hgmx.2016.04.001"
    "estado" => "S300"
    "fechaPublicacion" => "2016-07-01"
    "aid" => "70"
    "copyright" => "Sociedad M&#233;dica del Hospital General de M&#233;xico"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Med Hosp Gen Mex. 2016;79:150-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1679
      "formatos" => array:3 [
        "EPUB" => 58
        "HTML" => 1127
        "PDF" => 494
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Hepatitis E virus incidence in patients with non-identified acute viral hepatitis in Mexico"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "150"
          "paginaFinal" => "154"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Incidencia del Virus de Hepatitis E en pacientes con hepatitis viral aguda no identificada en M&#233;xico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1956
              "Ancho" => 2666
              "Tamanyo" => 252391
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Areas and regions in Mexico where HEV cases were found&#46; These areas are marked with different colors&#46; The region marked in blue is the area where most of the cases occurred&#44; the region marked in red is the 2nd and the region marked in yellow is where the least cases were found&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Berebichez-Fridman, R&#46; V&#225;zquez-Campuzano, J&#46;A&#46; Galnares-Olalde, R&#46; Blachman-Braun"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Berebichez-Fridman"
            ]
            1 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "V&#225;zquez-Campuzano"
            ]
            2 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Galnares-Olalde"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Blachman-Braun"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106316300117?idApp=UINPBA00004N"
    "url" => "/01851063/0000007900000003/v1_201608260031/S0185106316300117/v1_201608260031/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0185106316300518"
    "issn" => "01851063"
    "doi" => "10.1016/j.hgmx.2016.05.021"
    "estado" => "S300"
    "fechaPublicacion" => "2016-07-01"
    "aid" => "98"
    "copyright" => "Sociedad M&#233;dica del Hospital General de M&#233;xico"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Med Hosp Gen Mex. 2016;79:136-43"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1534
      "formatos" => array:3 [
        "EPUB" => 59
        "HTML" => 1172
        "PDF" => 303
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Prevalence of sleep disorders&#44; daytime sleepiness and clinical symptomatology in older adults"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "136"
          "paginaFinal" => "143"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia de trastornos de sue&#241;o&#44; somnolencia diurna y sintomatolog&#237;a cl&#237;nica en adultos mayores"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 801
              "Ancho" => 1605
              "Tamanyo" => 47646
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Sleep architecture of the elderly patients&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;&#193;&#46; Mendoza-Mel&#233;ndez, U&#46; Jimenez-Correa, A&#46; Gallegos-Cari, F&#46; Ayala-Guerrero, A&#46; Jim&#233;nez-Anguiano"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "Mendoza-Mel&#233;ndez"
            ]
            1 => array:2 [
              "nombre" => "U&#46;"
              "apellidos" => "Jimenez-Correa"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Gallegos-Cari"
            ]
            3 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Ayala-Guerrero"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Jim&#233;nez-Anguiano"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0185106316300518?idApp=UINPBA00004N"
    "url" => "/01851063/0000007900000003/v1_201608260031/S0185106316300518/v1_201608260031/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Clinical performance and resource utilisation of a respiratory intensive care unit&#46; Analysis of five years of clinical activity"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "144"
        "paginaFinal" => "149"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "P&#46; &#193;lvarez-Maldonado, A&#46; P&#233;rez-Rosales, G&#46; Cueto-Robledo, U&#46; Cer&#243;n-D&#237;az, C&#46; N&#250;&#241;ez-P&#233;rez-Redondo, F&#46; Navarro-Reynoso, R&#46; Cicero-Sabido"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "P&#46;"
            "apellidos" => "&#193;lvarez-Maldonado"
            "email" => array:1 [
              0 => "pamyacs&#64;yahoo&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "P&#233;rez-Rosales"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "G&#46;"
            "apellidos" => "Cueto-Robledo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "U&#46;"
            "apellidos" => "Cer&#243;n-D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "N&#250;&#241;ez-P&#233;rez-Redondo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Navarro-Reynoso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Cicero-Sabido"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Department of Pulmonology and Thoracic Surgery&#44; Hospital General de M&#233;xico &#8220;Dr&#46; Eduardo Liceaga&#8221;&#44; Mexico City&#44; Mexico"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Head of the ICU&#44; Hospital &#193;ngeles Lindavista and Hospital &#193;ngeles Acoxpa&#44; Assigned to the ICU&#44; Hospital Espa&#241;ol de M&#233;xico&#44; Mexico City&#44; Mexico"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "School of Medicine&#44; UNAM&#44; Mexico City&#44; Mexico"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author at&#58; Servicio de Neumolog&#237;a y Cirug&#237;a de T&#243;rax&#44; Hospital General de M&#233;xico &#8220;Dr&#46; Eduardo Liceaga&#8221;&#44; c&#46; Dr&#46; Balmis 148&#44; C&#46;P&#46; 06726 Mexico City&#44; Mexico&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Rendimiento cl&#237;nico y uso de recursos de una unidad de cuidados intensivos respiratorios&#46; An&#225;lisis de cinco a&#241;os de actividad asistencial"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1212
            "Ancho" => 1635
            "Tamanyo" => 95648
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Revised Rapoport&#8211;Teres method graph for intensive care units graduated in standard deviations &#91;SD&#93;&#46; Coordinates within &#177;2 SD indicate that the performance of an ICU is consistent with that of its peers&#44; units in Project IMPACT considered &#8220;standard&#8221; against which it is compared&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Improving intensive care unit performance is a primary goal in quality of care management&#46; To achieve this improvement&#44; measuring with tools that enable us to make comparisons with proposed standards is necessary&#46; One tool currently used by intensive care units in North America&#44; more specifically in the United States and in some Mexican units is the Rapoport&#8211;Teres method&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> This method&#44; which plots clinical performance and costs on two axes using relatively easy to obtain information and is not very complex to interpret visually&#44; was initially described in 1994&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Since then it has been used by intensive care units in Project IMPACT&#44; a multi-centre database in the U&#46;S&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> In 2007&#44; the method was recalibrated to adjust it to more contemporary clinical results and resource utilisation without sacrificing too much of its simplicity&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> The expected benefit of performing this type of analysis includes&#44; among others&#44; comparing the performance results of one unit with other intensive care units considered to be &#8220;standard&#8221;&#44; so that&#44; should sub-standard performance results be obtained&#44; the care model of high-performance units can be copied &#40;care&#44; protocols&#44; supplies&#44; etc&#46;&#41;&#44; or&#44; should a satisfactory result be obtained&#44; the current strategies and care model can continue to be used&#46; The analysis also enables clinical performance and resource utilisation to be compared for the same unit in different periods&#44; to be able to describe the changes and possible phenomena related to those changes&#46; The objective of this study is to describe and analyse the clinical performance and resource utilisation of the respiratory intensive care unit &#40;RICU&#41; of a public hospital over a 5-year period &#40;March 2010&#8211;March 2015&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Type of study</span><p id="par0010" class="elsevierStylePara elsevierViewall">Cross-sectional&#44; comparative&#44; retrospective study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patients and site</span><p id="par0015" class="elsevierStylePara elsevierViewall">All patients admitted to the RICU belonging to the Department of Pulmonology and Thoracic Surgery at the &#8220;Dr&#46; Eduardo Liceaga&#8221; General Hospital of Mexico&#44; a public teaching hospital with 901 beds&#44; during the period from 1 March 2010 to 1 March 2015 were included&#46; Readmissions and patients under 18 years old were excluded from the analysis&#46; The RICU is one of eight intensive care units within the General Hospital of Mexico and it has seven beds&#46; The RICU has a multidisciplinary team that includes a certified critical care physician and pulmonologist during the morning shift&#44; as well as pulmonology residents&#44; rotating internal medicine residents in the morning&#44; afternoon&#44; and night shifts supported by a certified pulmonologist in charge of the Department&#46; The nurse&#8211;patient ratio is from 1&#58;1 to 1&#58;3 while the ratio of nurse specialising in critical care medicine to patients is from 1&#58;3 to 1&#58;7&#46; The RICU also has respiratory therapists during the morning shifts and on weekends&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Source of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">All data for the analysis were taken from the <span class="elsevierStyleItalic">DeDUCIR</span> &#40;<span class="elsevierStyleBold">De</span>posito de <span class="elsevierStyleBold">D</span>atos de la <span class="elsevierStyleBold">UCIR</span> &#91;RICU Data Deposit&#93;&#41; database&#46; This Excel database was implemented in 2010 and was based on the local BASUTI database<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> and the multi-centre intensive care unit BDM-TI database&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> It includes data on demographics&#44; severity and prognosis&#44; time on mechanical ventilation&#44; stay in the hospital and ICU&#44; mortality&#44; procedures&#44; and complications&#44; among others&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Revised Rapoport&#8211;Teres method</span><p id="par0025" class="elsevierStylePara elsevierViewall">Rapoport proposed a two-dimensional method that plots clinical performance &#40;standardised clinical performance index<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>SCPI&#41; and cost-effectiveness &#40;standardised resource utilisation index<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>SRUI&#41; onto two axes&#44; which are calculated according to the adjusted 2007 model<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> as follows&#58;</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SCPI</span> &#40;<span class="elsevierStyleItalic">x-axis</span>&#41;&#58; to obtain the standardised clinical performance index&#44; first the difference in survival &#40;&#916;Survival&#41; of the study population is obtained by subtracting expected survival from observed survival as follows&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia>To adjust this difference&#44; the mean difference in survival &#40;0&#46;110&#41; was extracted and divided by the standard deviation of the difference in survival &#40;4&#46;668&#41; obtained from the group of patients from the adjusted Rapoport model&#46; The result is the <span class="elsevierStyleItalic">x</span>-axis value or SCPI&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">SRUI</span> &#40;<span class="elsevierStyleItalic">y-axis</span>&#41;&#58; to obtain the standardised resource utilisation index a value was assigned to the days of stay in the ICU and to the post-ICU days for each patient&#46; The highest value is given to the first day in the ICU &#40;4 points&#41;&#44; a value of 2&#46;5 points for each subsequent day in the ICU&#44; and one point to the post-ICU days&#46; A mean value of the points obtained from all the patients is called &#8220;<span class="elsevierStyleItalic">weighted hospital days&#8221;</span> &#40;WHD&#41;&#46; Based on a linear regression analysis in the revised Rapoport model&#44; a need was seen to submit the WHD value to a logarithmic equation &#40;base 10&#41; to obtained the &#8220;<span class="elsevierStyleItalic">expected weighted hospital days&#8221;</span> &#40;WHDe&#41;&#44; which in addition to including the mortality of the study population&#44; includes independent variables that were identified as predictive of ICU outcome as detailed below&#58;<elsevierMultimedia ident="eq0010"></elsevierMultimedia>Afterwards&#44; the difference in hospital days was obtained by subtracting the expected weighted hospital days from the actual weighted hospital days&#58;<elsevierMultimedia ident="eq0015"></elsevierMultimedia>The mean &#916;WHD &#40;&#8722;0&#46;232&#41; was subtracted from this difference and was divided by the &#916;WHD standard deviation &#40;3&#46;786&#41; obtained from the group of patients from the adjusted Rapoport model&#46; The result is the <span class="elsevierStyleItalic">y</span>-axis value&#44; or SRUI&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">For visual interpretation purposes&#44; the SCPI and SRUI values are plotted on a four-quadrant coordinate graph designed for this purpose that enables the results to be compared with those obtained by other units participating in Project IMPACT in the U&#46;S&#46; &#40;in standard deviations&#44; SD&#41;&#46; Coordinates in upper right quadrant&#44; that is where SCPI and SRUI values are greater than zero&#44; indicate better survival and lower resource utilisation that expected&#44; while negative values for these indices indicate that mortality and resource utilisation are higher than expected&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">In a 5-year study period&#44; 1177 patients were admitted to the RICU&#46; Readmissions &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; and patients &#60;18 years old &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; were excluded from the analysis&#46; In 1136 patients&#44; the actual survival rate was 55&#37; and the survival rate predicted by SAPS-3 &#40;simplified acute physiology score&#41; was 74&#37;&#46; Characteristics of the included patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Of the patients who did not survive&#44; 18&#37; died within the first 48<span class="elsevierStyleHsp" style=""></span>h of their stay in the RICU and 8&#46;4&#37; died within the first 24<span class="elsevierStyleHsp" style=""></span>h of their stay&#46; The variables for calculating the SCPI and SRUI and the outcomes by period are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; The fraction of patients admitted for non-scheduled surgery&#44; patients on invasive mechanical ventilation&#44; and discharged to another hospital were included in the formula to calculate the SRUI&#46; Being discharged to another hospital was the only criterion &#40;from a series using the revised Rapoport method&#41; that applied for the study population according to the criteria considered to be a discharge to a post-acute care unit&#46; The SCPI for all patients was &#8722;4&#46;0 &#40;<span class="elsevierStyleItalic">x</span>-axis&#41; and the SRUI was 0&#46;94 &#40;<span class="elsevierStyleItalic">y</span>-axis&#41;&#46; This places the overall performance in the upper left quadrant &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The expenses an ICU generates can account for up to one third of the expenses generated by a hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> The most ill patients&#44; moreover&#44; will be more likely to die in intensive care units in comparison with other areas during their hospital stay&#46; Both aspects make ICU spaces complex to administer&#44; either in managing resources or strategies that seek to improve their clinical outcomes&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As for other areas of a hospital&#44; there are many ways for the ICU to evaluate the cost of healthcare interventions and its impact on the outcomes obtained&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;8&#8211;10</span></a> Given the diversity of methods and the complexity of defining the cost derived from the change in the health of an individual or group of individuals with different conditions&#44; or even more&#44; defining the monetary value of a life&#44; often times the rationale for making these measurements is to self-assess the performance of an ICU over time&#46; One example of a practical tool that has been successful due to its simplicity for measuring the performance of an ICU is the Rapoport method which combines clinical assessment &#40;SCPI&#41; with financial measurements &#40;SRUI&#41;&#44; enabling where improvements are required to be identified and graphically comparing performance with other ICUs&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Although the resource utilisation index in the RICU &#40;SRUI&#41; is within an acceptable parameter &#40;&#177;2 SD&#44; which is consistent with the average performance of its peers&#44; i&#46;e&#46; 135 ICUs participating in Project IMPACT&#41;&#44; its clinical performance is below standard&#46; The costs alone give us an incomplete view of the overall performance of an ICU since units with sub-standard care can have lower resource utilisation and an inappropriately high mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> Furthermore&#44; resources in an ICU may be scarce or absent&#44; which results in a deficient clinical performance&#46; Resources should not be understood simply as supplies&#44; since an ICU encompasses a structure&#44; with a physical area&#44; equipment &#40;which includes supplies&#41;&#44; and staff &#40;human team&#41;&#44; and the ways in which the staff carry out their actions &#40;processes&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Yet the analysis conducted when adjusting the Rapoport method in 2007 did not find a significant correlation between costs and mortality &#40;which means that an excessive use of resources is not necessary associated with exceptional clinical performance or vice versa&#41;&#44; in the particular case of the RICU a trend has been observed that clinical performance improves when more resources are used&#44; which could suggest that identifying areas of opportunity to inject resources may result in benefits&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Unlike the care models of units with good performance from Project IMPACT and Mexican units that have reported their results using the Rapoport method&#44;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#44;11&#44;12</span></a> the RICU does not have critical care physicians available for care 24&#47;7&#46; In addition&#44; the ratio of nursing staff and respiratory therapists who are part of the RICU multi-disciplinary team is deficient&#46; Making sure healthcare staff resources coincide with patient needs is a key factor for quality of care in the ICU&#46; Patient safety is put at risk when the patient&#58;healthcare staff ratio exceeds certain limits and when the workload is excessive&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Strategic planning&#44; on the other hand&#44; is essential for care in the intensive care unit to prosper&#44; providing good patient care and enabling an efficient use of resources&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> The RICU has implemented its own quality of care management systems which have merited recognition in the international scientific media&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a> a mid-term work plan &#40;2014&#8211;2017&#41;&#44; and a long-term vision&#46; This suggests to us that the on-going efforts to improve care are present with strategies that are applied in high-performing units in Mexico and the United States&#46; The RICU is currently implementing the strategies from the <span class="elsevierStyleItalic">Bacteremia Zero</span><a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> and <span class="elsevierStyleItalic">Pneumonia Zero</span><a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> projects&#44; which have demonstrated excellent results in Europe and the U&#46;S&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> in addition to implementing a hand hygiene adherence program that promotes a culture of quality&#46; The opportunities for improvement by implementing strategies that do not require large investments or complex technology are innumerable and the RICU is not ignorant of these efforts&#44; which also include collaborations with similar units in Mexico&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> Moreover&#44; in 2017 the RICU and the Department of Pulmonology are expected to move into a new physical area&#44; a building to care for patients with cardiopulmonary conditions which is planned to have facilities with a design and equipment that are adapted to the current standards&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">There are some limitations to the presented analysis which deserve mention&#46; First&#44; to calculate the SCPI and SRUI the expected survival according to the SAPS-3 prediction model was used&#44; and not that according to the MPM<span class="elsevierStyleInf">0</span>-III model as in the revised Rapoport method&#46; It must be taken into account that the tool was only validated for the latter model&#46; Even if the study population were eligible for the MPM model&#44; the RICU has a unique population of patients with predominantly respiratory conditions &#40;medical and surgical&#41;&#44; in which the model calibrated for WHD could be inadequate&#46; Second&#44; nearly one fifth of the patients who died in the RICU did so within the first 48<span class="elsevierStyleHsp" style=""></span>h of their stay&#44; which makes us think that patients who are too critically ill are admitted and that SAPS-3 may overestimate the expected survival &#40;like other models&#41;&#46; In that case&#44; it would require a local validation of the prediction model to adjust it to the patient population cared for&#46; Third&#44; due to not knowing the proportion of patients who required mechanical ventilation in the first hour of admission to the RICU&#44; the total proportion of patients on mechanical ventilation was used to calculate the SRUI&#46; However&#44; this aspect makes it so that SRUI is underestimated&#46; Fourth&#44; when the Rapoport method was adjusted in 2007&#44; some speculations were proposed to explain why better survival was observed in the ICUs at that time compared with the original method 13 years earlier in 1994&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> for example&#44; the greater role of 24-h critical care physicians&#44; the intervention of multidisciplinary teams in medical rounds&#44; the implementation of a series of measures to improve the quality of care&#44; and the pharmaceutical and technological advances&#44; among others&#46; These speculations may play a role 8 years after the last calibration of the Rapoport method&#46; That is&#44; a new calibration may now be necessary&#46; Lastly&#44; the results of the RICU performance cannot be compared with those obtained by other Mexican ICUs since the units that reported their analysis with the method did so before it had been calibrated &#91;before 2007&#93;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0085" class="elsevierStylePara elsevierViewall">Although the resource utilisation index in the RICU is within an acceptable parameter&#44; a clinical performance below the standard is observed&#46; Copying the care model of ICUs with good performance could be beneficial for the RICU to improve its performance&#46; As the RICU has improvement programs in its protocols and processes&#44; it mainly needs to copy aspects of the care model of other ICUs with good performance&#46; Hiring specialised&#44; multi-disciplinary staff for shifts&#44; improving its physical structure and equipment&#44; and reinforcing its processes&#44; among others&#44; are areas of opportunity&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical disclosure</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest related to the preparation of this manuscript&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:14 [
        0 => array:3 [
          "identificador" => "xres721839"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Objective"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Material and methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec726906"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres721840"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Antecedente"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Objetivo"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Material y M&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec726907"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Type of study"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Patients and site"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Source of data"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Revised Rapoport&#8211;Teres method"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusions"
        ]
        9 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Ethical disclosure"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflict of interest"
        ]
        12 => array:2 [
          "identificador" => "xack239832"
          "titulo" => "Acknowledgements"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-08-22"
    "fechaAceptado" => "2016-05-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec726906"
          "palabras" => array:5 [
            0 => "Clinical performance"
            1 => "Cost-effectiveness"
            2 => "Resource utilisation"
            3 => "Quality management"
            4 => "Intensive care"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec726907"
          "palabras" => array:5 [
            0 => "Rendimiento cl&#237;nico"
            1 => "Costo-efectividad"
            2 => "Uso de recursos"
            3 => "Gesti&#243;n de calidad"
            4 => "Terapia intensiva"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Improving intensive care unit &#40;ICU&#41; performance is a primary goal in quality of care management&#59; for this purpose&#44; measuring with tools that enable us to make comparisons with proposed standards is necessary&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical performance and resource utilisation of a respiratory ICU &#40;RICU&#41; over a 5-year period&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional&#44; retrospective&#44; comparative study was conducted in the RICU of a teaching hospital&#46; Using the revised Rapoport&#8211;Teres method&#44; the standardised clinical performance index &#40;SCPI&#41; and the standardised resource utilisation index &#40;SRUI&#41; were calculated annually and for the entire study period&#46; The results were compared with those obtained by the ICUs participating in Project IMPACT &#40;in standard deviations&#41; in a four-quadrant coordinate graph designed for this purpose&#46; SCPI and SRUI values greater than zero indicate better survival and a lower resource utilisation than expected&#46; Values below zero indicate a mortality and resource utilisation higher than expected&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In the study period&#44; 1177 patients were admitted to the RICU&#46; Readmissions &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; and patients &#60;18 years old &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41; were excluded from the analysis&#46; In 1136 patients&#44; the observed survival rate was 55&#37; and the survival rate predicted by SAPS-3 &#40;simplified acute physiology score&#41; was 74&#37;&#46; The fraction of unscheduled surgery patients&#44; those receiving invasive mechanical ventilation&#44; and those discharged to another hospital were included in the SRUI calculation&#46; The SCPI and the SRUI for the entire study period were &#8722;4&#46;0 and 0&#46;94 respectively&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Although the resource utilisation index in the RICU is within an acceptable parameter&#44; a clinical performance below the standard is observed&#46; Copying the care model of ICUs with good performance could be beneficial for the RICU to improve its performance&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedente</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Mejorar el rendimiento de la unidad de cuidados intensivos &#40;UCI&#41; es un objetivo primordial en la gesti&#243;n de calidad&#44; para esto&#44; es necesario medir con herramientas que nos permitan hacer comparaciones con est&#225;ndares propuestos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir el rendimiento cl&#237;nico y uso de recursos de una UCI respiratoria &#40;UCIR&#41; en 5 a&#241;os&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal retrospectivo comparativo en la UCIR de un hospital p&#250;blico escuela&#46; Utilizando el m&#233;todo revisado de Rapoport&#8211;Teres se hizo el c&#225;lculo del &#237;ndice de rendimiento cl&#237;nico estandarizado &#40;IRCE&#41; y del &#237;ndice de uso de recursos estandarizado &#40;IURE&#41; de manera global y por periodos de un a&#241;o comparando los resultados con los obtenidos por las UCIs participantes del proyecto IMPACT &#40;en desviaciones est&#225;ndar&#41; en un gr&#225;fico de coordenadas de cuatro cuadrantes dise&#241;ado para este prop&#243;sito&#46; Valores de IRCE e IURE mayores a cero indican mejor sobrevida y menor uso de recursos que los esperados&#46; Valores menores a cero indican una mortalidad y uso de recursos mayores a los esperados&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">En el periodo de estudio ingresaron a la UCIR 1177 pacientes&#44; fueron excluidos para el an&#225;lisis los re-ingresos &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41; y los &#60;18 a&#241;os &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&#46; En 1136 pacientes la sobrevida actual fue de 55&#37;&#44; la sobrevida predicha por SAPS-3 &#40;<span class="elsevierStyleItalic">simplified acute physiology score</span>&#41; fue de 74&#37;&#46; Para el c&#225;lculo del IURE fueron incluidos en la formula la fracci&#243;n de pacientes ingresados por cirug&#237;a no programada&#44; pacientes en ventilaci&#243;n mec&#225;nica invasiva y los egresados a otro hospital&#46; El IRCE para todo el periodo de estudio fue de &#8722;4&#46;0 y el IURE de 0&#46;94&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Aunque el &#237;ndice de uso de recursos de la UCIR est&#225; en un par&#225;metro aceptable&#44; se observa un rendimiento cl&#237;nico por debajo del est&#225;ndar&#46; Copiar el modelo de unidades con buen rendimiento podr&#237;a resultar de beneficio para mejorar el desempe&#241;o de la UCIR&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Antecedente"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1212
            "Ancho" => 1635
            "Tamanyo" => 95648
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Revised Rapoport&#8211;Teres method graph for intensive care units graduated in standard deviations &#91;SD&#93;&#46; Coordinates within &#177;2 SD indicate that the performance of an ICU is consistent with that of its peers&#44; units in Project IMPACT considered &#8220;standard&#8221; against which it is compared&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; SAPS-3&#44; simplified acute physiology score 3&#59; SOFA&#44; sequential organ failure assessment&#59; ICU&#44; intensive care unit&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span>17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; male&#47;female &#91;&#37;&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">592&#47;544 &#91;52&#47;48&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SAPS-3</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">SOFA</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;2<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span>4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Invasive mechanical ventilation&#44; &#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Origin</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonology hospitalisation ward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">321 &#91;28&#46;3&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emergency department&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">247 &#91;21&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pulmonology operating room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">241 &#91;21&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other hospitalisation ward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">149 &#91;13&#46;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Operating room in other departments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">116 &#91;10&#46;2&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#91;2&#46;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Outpatient pulmonology appointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#91;1&#46;7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#91;0&#46;9&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Reason for admission to the ICU</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">523 &#91;46&#46;0&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Post-operative &#91;elective or non-elective&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">375 &#91;33&#46;0&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiovascular failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">180 &#91;15&#46;8&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neurological failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#91;3&#46;3&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#91;1&#46;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metabolic failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#91;0&#46;4&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Haematological failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#91;0&#46;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Liver failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#91;0&#46;1&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1186604.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients included&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">SCPI&#44; standardised clinical performance index&#59; SRUI&#44; standardised resource utilisation index&#59; SAPS-3&#44; simplified acute physiology score&#59; WHD&#44; weighted hospital days&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period &#91;March&#8211;March&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2010&#8211;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2011&#8211;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2012&#8211;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2013&#8211;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2014&#8211;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total 5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total patients in the period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">230&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">196&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total patients without readmissions&#44; without patients &#60;18 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">272&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actual survival &#91;real&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Expected survival per SAPS-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;739&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;736&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;748&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difference in survival &#91;&#916;Survival&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;10&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;20&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;18&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;18&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">SCPI &#91;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">x</span></span><span class="elsevierStyleBold">-axis&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">4&#46;29</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">2&#46;29</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">5&#46;12</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">4&#46;42</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">3&#46;88</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">4&#46;00</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#37; Unscheduled surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#37; Mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#37; Discharged to external acute care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Actual weighted hospital days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Predicted weighted hospital days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Difference in hospital days &#91;&#916;WHD&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;3&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">SRUI &#91;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">y</span></span><span class="elsevierStyleBold">-axis&#93;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">2&#46;30</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">0&#46;91</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">2&#46;45</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">1&#46;49</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;<span class="elsevierStyleBold">0&#46;65</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;94</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1186603.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Variables for calculating the SCPI and SRUI and outcomes by period&#46;</p>"
        ]
      ]
      3 => array:5 [
        "identificador" => "eq0005"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:5 [
          "Matematica" => "&#916;Survival&#61;&#40;actual&#8201;&#8202;&#8202;survival&#8722;expected&#8201;&#8202;&#8202;survival&#41;&#215;100"
          "Fichero" => "STRIPIN_si1.jpeg"
          "Tamanyo" => 3289
          "Alto" => 14
          "Ancho" => 376
        ]
      ]
      4 => array:5 [
        "identificador" => "eq0010"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:5 [
          "Matematica" => "Log10&#40;WHD&#41;&#61;1&#46;008&#43;0&#46;753&#215;&#40;&#37;&#8201;&#8202;&#8202;in-hospital&#8201;&#8202;&#8202;deaths&#41;&#43;0&#46;432&#215;&#40;&#37;&#8201;&#8202;&#8202;unscheduled&#8201;&#8202;&#8202;surgery&#41;&#43;0&#46;228&#215;&#40;&#37;&#8201;&#8202;&#8202;mechanical&#8201;&#8202;&#8202;ventilation&#8201;&#8202;&#8202;within&#8201;&#8202;&#8202;1&#8201;&#8202;&#8202;h&#8201;&#8202;&#8202;of&#8201;&#8202;&#8202;admission&#8201;&#8202;&#8202;to&#8201;&#8202;&#8202;the&#8201;&#8202;&#8202;ICU&#41;&#8722;0&#46;708&#215;&#40;&#37;&#8201;&#8202;&#8202;patients&#8201;&#8202;&#8202;discharged&#8201;&#8202;&#8202;to&#8201;&#8202;&#8202;post-acute&#8201;&#8202;&#8202;care&#8201;&#8202;&#8202;outside&#8201;&#8202;&#8202;the&#8201;&#8202;&#8202;hospital&#41;"
          "Fichero" => "STRIPIN_si2.jpeg"
          "Tamanyo" => 14604
          "Alto" => 152
          "Ancho" => 390
        ]
      ]
      5 => array:5 [
        "identificador" => "eq0015"
        "tipo" => "MULTIMEDIAFORMULA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Formula" => array:5 [
          "Matematica" => "&#916;WHD&#61;WHD&#8722;WHDe"
          "Fichero" => "STRIPIN_si3.jpeg"
          "Tamanyo" => 1343
          "Alto" => 11
          "Ancho" => 151
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calidad y costo-efectividad en la atenci&#243;n del paciente cr&#237;tico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46;A&#46; Elguea Echavarr&#237;a"
                            1 => "U&#46;W&#46; Cer&#243;n D&#237;az"
                            2 => "J&#46;G&#46; Esponda Prado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int"
                        "fecha" => "2012"
                        "volumen" => "26"
                        "paginaInicial" => "42"
                        "paginaFinal" => "50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A method for assessing the clinical performance and cost-effectiveness of intensive care units&#58; a multicenter inception cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Rapoport"
                            1 => "D&#46; Teres"
                            2 => "S&#46; Lemeshow"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1994"
                        "volumen" => "22"
                        "paginaInicial" => "1385"
                        "paginaFinal" => "1391"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8062559"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Project IMPACT&#58; results from a pilot validity study of a new observational database"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Project IMPACT Clinical Implementation Committee"
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46;F&#46; Cook"
                            1 => "W&#46;A&#46; Visscher"
                            2 => "C&#46;L&#46; Hobbs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000039570.92750.7A"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "30"
                        "paginaInicial" => "2765"
                        "paginaFinal" => "2770"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12483071"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A revised method to assess intensive care unit clinical performance and resource utilization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "B&#46;H&#46; Nathanson"
                            1 => "T&#46;L&#46; Higgins"
                            2 => "D&#46; Teres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.CCM.0000275272.57237.53"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2007"
                        "volumen" => "35"
                        "paginaInicial" => "1853"
                        "paginaFinal" => "1862"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17568328"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Base de datos para el control de calidad y utilizaci&#243;n de recursos en la Unidad de Terapia Intensiva"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "U&#46; Cer&#243;n"
                            1 => "A&#46; Sierra"
                            2 => "R&#46; Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int"
                        "fecha" => "1996"
                        "volumen" => "10"
                        "paginaInicial" => "105"
                        "paginaFinal" => "201"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rendimiento cl&#237;nico y costo-efectividad de tres unidades de terapia intensiva mexicanas incluidas en la base de datos multic&#233;ntrica de terapia intensiva"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "U&#46;W&#46; Cer&#243;n D&#237;az"
                            1 => "J&#46; Esponda Prado"
                            2 => "M&#46; Borbolla Paya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int"
                        "fecha" => "2000"
                        "volumen" => "14"
                        "paginaInicial" => "41"
                        "paginaFinal" => "49"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An update on cost-effectiveness analysis in critical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;F&#46; Shorr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Crit Care"
                        "fecha" => "2002"
                        "volumen" => "8"
                        "paginaInicial" => "337"
                        "paginaFinal" => "343"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12386495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Costo efectividad de la atenci&#243;n en cuidados intensivos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;J&#46; Villag&#243;mez Ortiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int"
                        "fecha" => "2012"
                        "volumen" => "4"
                        "paginaInicial" => "192"
                        "paginaFinal" => "193"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is critical care ready for an economic surrogate endpoint&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;E&#46; Wilcox"
                            1 => "G&#46;D&#46; Rubenfeld"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13054-015-0947-0"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26067467"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive care performance&#58; how should we monitor performance in the future&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;K&#46; Timmers"
                            1 => "M&#46;H&#46; Verhofstad"
                            2 => "K&#46;G&#46; Moons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5492/wjccm.v3.i4.74"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "3"
                        "paginaInicial" => "74"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25374803"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An&#225;lisis de costo-efectividad por el m&#233;todo de Rapoport en un a&#241;o de actividad asistencial en una unidad de terapia intensiva polivalente privada en M&#233;xico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Abascal Caloca"
                            1 => "U&#46;W&#46; Cer&#243;n D&#237;az"
                            2 => "J&#46;P&#46; V&#225;zquez Mathieu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int"
                        "fecha" => "2006"
                        "volumen" => "1"
                        "paginaInicial" => "5"
                        "paginaFinal" => "11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparaci&#243;n del rendimiento cl&#237;nico y costo-efectividad en tres periodos durante nueve a&#241;os de actividad asistencial de una unidad de terapia intensiva"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46;W&#46; Cer&#243;n D&#237;az"
                            1 => "C&#46; Abascal"
                            2 => "A&#46; Sierra Unzueta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Asoc Mex Med Crit Ter Int"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "126"
                        "paginaFinal" => "135"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient mortality is associated with staff resources and workload in the ICU&#58; a multicenter observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Neuraz"
                            1 => "C&#46; Gu&#233;rin"
                            2 => "C&#46; Payet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0000000000001015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "1587"
                        "paginaFinal" => "1594"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25867907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guide to strategic planning in critical care medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Kyeremanteng"
                            1 => "G&#46; D&#8217;Egidio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Hosp Admin"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "93"
                        "paginaFinal" => "96"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cambios en tres indicadores de calidad despu&#233;s de la implementaci&#243;n de estrategias de mejora en la unidad de cuidados intensivos respiratorios"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; &#193;lvarez Maldonado"
                            1 => "G&#46; Cueto Robledo"
                            2 => "R&#46; Cicero Sabido"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2014.01.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "142"
                        "paginaFinal" => "148"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24661920"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measuring the quality of intensive care medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;C&#46; Mart&#237;n-Delgado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2014.04.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24951246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "<a id="intr0005" class="elsevierStyleInterRef" href="http://www.semicyuc.org/temas/calidad/bacteriemia-zero">http&#58;&#47;&#47;www&#46;semicyuc&#46;org&#47;temas&#47;calidad&#47;bacteriemia-zero</a> &#91;accessed 1&#46;07&#46;15&#93;"
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "<a id="intr0010" class="elsevierStyleInterRef" href="http://www.semicyuc.org/temas/investigacion/proyectos-de-la-semicyuc/neumonia-zero">http&#58;&#47;&#47;www&#46;semicyuc&#46;org&#47;temas&#47;investigacion&#47;proyectos-de-la-semicyuc&#47;neumonia-zero</a> &#91;accessed 1&#46;07&#46;15&#93;"
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU&#58; the Spanish experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Palomar"
                            1 => "F&#46; &#193;lvarez-Lerma"
                            2 => "A&#46; Riera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3182923622"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "41"
                        "paginaInicial" => "2364"
                        "paginaFinal" => "2372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23939352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Task force for the review&#44; modification and development of quality indicators for respiratory intensive care units in Mexico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; &#193;lvarez-Maldonado"
                            1 => "E&#46; Bautista-Bautista"
                            2 => "V&#46; Huizar-Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2013.12.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2015"
                        "volumen" => "51"
                        "paginaInicial" => "357"
                        "paginaFinal" => "358"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25278215"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack239832"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0125" class="elsevierStylePara elsevierViewall">Thank you to the nurses&#44; residents&#44; pulmonologists&#44; and respiratory therapists who provide their valuable service in the Respiratory Intensive Care Unit at the General Hospital of Mexico&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/01851063/0000007900000003/v1_201608260031/S018510631630049X/v1_201608260031/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "40782"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/01851063/0000007900000003/v1_201608260031/S018510631630049X/v1_201608260031/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S018510631630049X?idApp=UINPBA00004N"
]

Article information

ISSN: 01851063
Original language: English

DOI:10.1016/j.hgmx.2016.05.019

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	9	2	11
2024 September	26	6	32
2024 August	21	10	31
2024 July	26	7	33
2024 June	20	7	27
2024 May	14	4	18
2024 April	27	5	32
2024 March	19	8	27
2024 February	17	15	32
2024 January	40	7	47
2023 December	25	9	34
2023 November	30	8	38
2023 October	19	6	25
2023 September	11	2	13
2023 August	17	2	19
2023 July	14	7	21
2023 June	21	7	28
2023 May	54	5	59
2023 April	42	2	44
2023 March	28	1	29
2023 February	32	9	41
2023 January	18	4	22
2022 December	12	4	16
2022 November	19	9	28
2022 October	12	6	18
2022 September	14	6	20
2022 August	7	11	18
2022 July	15	9	24
2022 June	7	6	13
2022 May	12	6	18
2022 April	11	10	21
2022 March	15	12	27
2022 February	10	5	15
2022 January	16	6	22
2021 December	16	8	24
2021 November	19	14	33
2021 October	22	11	33
2021 September	16	13	29
2021 August	16	5	21
2021 July	14	9	23
2021 June	8	12	20
2021 May	13	6	19
2021 April	64	9	73
2021 March	31	9	40
2021 February	28	7	35
2021 January	32	11	43
2020 December	23	20	43
2020 November	19	2	21
2020 October	9	6	15
2020 September	21	8	29
2020 August	26	6	32
2020 July	21	8	29
2020 June	19	7	26
2020 May	26	3	29
2020 April	17	2	19
2020 March	13	3	16
2020 February	17	3	20
2020 January	17	9	26
2019 December	23	2	25
2019 November	10	5	15
2019 October	17	3	20
2019 September	24	5	29
2019 August	13	1	14
2019 July	16	1	17
2019 June	29	11	40
2019 May	96	4	100
2019 April	46	19	65
2019 March	6	7	13
2019 February	10	4	14
2019 January	4	2	6
2018 December	9	2	11
2018 November	4	6	10
2018 October	6	5	11
2018 September	7	3	10
2018 August	7	1	8
2018 July	2	5	7
2018 June	8	0	8
2018 May	15	11	26
2018 April	4	0	4
2018 March	6	2	8
2018 February	4	2	6
2018 January	7	3	10
2017 December	6	3	9
2017 November	6	2	8
2017 October	6	2	8
2017 September	7	6	13
2017 August	6	10	16
2017 July	16	3	19
2017 June	32	5	37
2017 May	29	18	47
2017 April	23	38	61
2017 March	23	41	64
2017 February	20	10	30
2017 January	18	1	19
2016 December	28	15	43
2016 November	60	9	69
2016 October	68	11	79
2016 September	64	12	76
2016 August	21	4	25
2016 July	4	7	11

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter