The Cardiac Intensive Care Unit Network in Croatia

    Authors

    Abstract

    Organization and outcome of health care in general, as well as, of cardiac intensive care units (CICU) highly depends on gross domestic product (GDP). We had been witnessing evolution of CICU from point of rapid resuscitation to intervention, and finally compendious critical care. (1) Authors analyze organization of CICU on national level in Croatia and compare it with economically more developed countries. Croatian GDP per capita is 35-40% of European (EU-28) average, which groups us among economically less developed European countries. (2) Data were collected from thirty-four Croatian hospitals, and analyzed during September and October 2016. (1) Croatia has 5 CICU per million inhabitants with mostly 5-6 beds (range of 1-9), on average one nurse on 2.7 patients (significant variation according to hospital size) and less than 4 beds per one physician (mostly cardiologists, lesser extent during night shifts). In addition, 76.5% of ICUs had 24/7 transthoracic echocardiography, 26.5% 24/7 transesophageal echocardiography, one third without therapeutic hypothermia, and 23.5% without ECMO as available treatment. This representative, nationwide sample of Croatian CICUs demonstrated considerable variation of key elements of structures with respect to hospital size and financial issues, what influenced following of present international guidelines. This kind of investigation revealed the space for improvement and has to be taken into account while proposing standards, reimbursement master plan, or quality assessment of national health system. (3)

    Keywords

    cardiac intensive care unit, organization, Croatia

    DOI

    https://doi.org/10.15836/ccar2017.345

    Literature

    1. Morrow DA, Fang JC, Fintel DJ, Granger CB, Katz JN, Kushner FG, et al. American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Council on Quality of Care and Outcomes Research. Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation. 2012 Sep 11;126(11):1408–28. https://doi.org/10.1161/CIR.0b013e31826890b0
    2. Eurostat. Eurostat regional yearbook 2017. https://doi.org/10.2785/257716
    3. Bonnefoy-Cudraz E, Bueno H, Casella G, De Maria E, Fitzsimons D, Halvorsen S, et al. Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function. Eur Heart J Acute Cardiovasc Care. 2017 Aug 1;2048872617724269:. https://doi.org/10.1177/2048872617724269
    Cardiologia Croatica
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    The Cardiac Intensive Care Unit Network in Croatia

    Extended Abstract
    Issue9-10
    Published
    Pages345
    PDF via DOIhttps://doi.org/10.15836/ccar2017.345
    cardiac intensive care unit
    organization
    Croatia

    Authors

    Ana Đuzel*ORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Marin PavlovORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Zdravko BabićORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia

    *Correspondence email: ana29.djuzel@gmail.com

    Abstract

    Organization and outcome of health care in general, as well as, of cardiac intensive care units (CICU) highly depends on gross domestic product (GDP). We had been witnessing evolution of CICU from point of rapid resuscitation to intervention, and finally compendious critical care. (1) Authors analyze organization of CICU on national level in Croatia and compare it with economically more developed countries. Croatian GDP per capita is 35-40% of European (EU-28) average, which groups us among economically less developed European countries. (2) Data were collected from thirty-four Croatian hospitals, and analyzed during September and October 2016. (1) Croatia has 5 CICU per million inhabitants with mostly 5-6 beds (range of 1-9), on average one nurse on 2.7 patients (significant variation according to hospital size) and less than 4 beds per one physician (mostly cardiologists, lesser extent during night shifts). In addition, 76.5% of ICUs had 24/7 transthoracic echocardiography, 26.5% 24/7 transesophageal echocardiography, one third without therapeutic hypothermia, and 23.5% without ECMO as available treatment. This representative, nationwide sample of Croatian CICUs demonstrated considerable variation of key elements of structures with respect to hospital size and financial issues, what influenced following of present international guidelines. This kind of investigation revealed the space for improvement and has to be taken into account while proposing standards, reimbursement master plan, or quality assessment of national health system. (3)

    Literature

    1. 1.
      Morrow DA, Fang JC, Fintel DJ, Granger CB, Katz JN, Kushner FG, et al. American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Clinical Cardiology, Council on Cardiovascular Nursing, and Council on Quality of Care and Outcomes Research. Evolution of critical care cardiology: transformation of the cardiovascular intensive care unit and the emerging need for new medical staffing and training models: a scientific statement from the American Heart Association. Circulation. 2012 Sep 11;126(11):1408–28.DOI
    2. 2.
      Eurostat. Eurostat regional yearbook 2017.DOI
    3. 3.
      Bonnefoy-Cudraz E, Bueno H, Casella G, De Maria E, Fitzsimons D, Halvorsen S, et al. Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function. Eur Heart J Acute Cardiovasc Care. 2017 Aug 1;2048872617724269:.DOI