Clinician Communication, Adherence to Protocols, and Presence of Pharmacists Improve Outcomes in ICUs

Clinician Communication, Adherence to Protocols, and Presence of Pharmacists Improve Outcomes in ICUs
Clinician Communication, Adherence to Protocols, and Presence of Pharmacists Improve Outcomes in ICUs

Oncologic patients are among the main users of intensive care units (ICUs), and they are vulnerable to infections and adverse drug reactions. However, relatively simple processes of organization, such as holding meetings to discuss clinical cases between oncologists and intensivists, using care protocols, and the presence of pharmacists in ICUs, can reduce the risk of these problems.1

These findings come from a retrospective cohort study of 9946 patients with cancer admitted to 70 ICUs, with 51 located in general hospitals and 19 in cancer cancers during 2013. This large study was coordinated by researchers from the D'Or Institute for Research and Education, IDOR (Brazil), in partnership with the University of Pittsburgh (USA) and several Brazilian institutions.

Approximately 1 of 6 people hospitalized in an ICU has cancer and 10% to 70% of patients with cancer need intensive care at least once in their life, depending on the type of cancer. In this study, cancer patients represented 17% of admissions in the participating ICUs.

"The cancer patient quantitatively represents a very large part of the admissions in the ICUs, in a way that intensive units have become an important support treatment for these patients," said research leader Marcio Soares, MD, PhD, from IDOR.

Survival was found to be higher in ICUs that follow processes such as having daily meetings between oncologists and intensivists to set goals and develop plans of care for patients; having the presence of a pharmacist; and following protocols already used in general ICUs to reduce infections and the risk of treatment-related complications.

The pharmacist presence is also essential due to the ever-larger number of treatment types against cancer, to avoid complications from toxicities and drug interactions, as well as to guide dose adjustments.

In addition, these measures also reduce costs in the ICU because resources are used more efficiently. Currently, an estimated 0.5% to 1% of a country's gross domestic product (GDP) is spent on intensive care, and that can be up to 10% of total spending on health, depending on the country.

Mortality rates for cancer patients did not differ between being admitted to a general hospital ICU or to specialized cancer treatment centers. If flow optimization measures are taken, survival rates are higher regardless of the type of ICU.

"Our population is aging and we expect an increase in demand from cancer patients seeking admission. We don't have specialized hospitals for everyone, but studies like ours can help to reduce the gap between hospitals," said Soares.

Reference

1. Soares M, Bozza FA, Azevedo LC, et al. Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol. 2016 Jul 18. doi: 10.1200/JCO.2016.66.9549. [Epub ahead of print]

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