The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil

ABSTRACT Objective: To describe the Epimed Monitor Database®, a Brazilian intensive care unit quality improvement database. Methods: We described the Epimed Monitor® Database, including its structure and core data. We presented aggregated informative data from intensive care unit admissions from 2010 to 2016 using descriptive statistics. We also described the expansion and growth of the database along with the geographical distribution of participating units in Brazil. Results: The core data from the database includes demographic, administrative and physiological parameters, as well as specific report forms used to gather detailed data regarding the use of intensive care unit resources, infectious episodes, adverse events and checklists for adherence to best clinical practices. As of the end of 2016, 598 adult intensive care units in 318 hospitals totaling 8,160 intensive care unit beds were participating in the database. Most units were located at private hospitals in the southeastern region of the country. The number of yearly admissions rose during this period and included a predominance of medical admissions. The proportion of admissions due to cardiovascular disease declined, while admissions due to sepsis or infections became more common. Illness severity (Simplified Acute Physiology Score - SAPS 3 - 62 points), patient age (mean = 62 years) and hospital mortality (approximately 17%) remained reasonably stable during this time period. Conclusion: A large private database of critically ill patients is feasible and may provide relevant nationwide epidemiological data for quality improvement and benchmarking purposes among the participating intensive care units. This database is useful not only for administrative reasons but also for the improvement of daily care by facilitating the adoption of best practices and use for clinical research.摘要 研究目的：介绍巴西重症监护病房质量改进数据库——Epimed监护数据库（Epimed Monitor Database®）。 研究方法：本研究对Epimed监护数据库（Epimed Monitor Database®）的架构与核心数据集进行阐述，采用描述性统计方法呈现2010至2016年重症监护病房收治患者的汇总信息，并介绍该数据库的扩张发展历程与巴西境内参与单位的地理分布情况。 研究结果：该数据库的核心数据涵盖人口统计学、行政与生理学参数，以及用于收集重症监护资源使用、感染事件、不良事件及临床最佳实践依从性核查清单相关详细数据的专用报表。截至2016年底，巴西318家医院的598家成人重症监护病房参与该数据库，累计开放重症监护床位8160张。多数参与单位位于巴西东南部的私立医院。此期间年度收治患者总量呈增长趋势，且以内科收治患者为主；因心血管疾病收治的患者占比有所下降，而因脓毒症或感染收治的患者占比逐渐升高。疾病严重程度（简化急性生理学评分3（Simplified Acute Physiology Score 3, SAPS 3）得分均值为62分）、患者平均年龄（62岁）及医院病死率（约17%）在此期间均保持相对稳定。 研究结论：大型私立重症患者数据库的构建具备可行性，可为参与该数据库的重症监护病房提供具有全国代表性的流行病学数据，用于质量改进与基准对照。该数据库不仅可用于行政管理，还能通过推动临床最佳实践的落地，为临床研究提供支持，进而助力日常诊疗质量的提升。