A Ten-Year Review of the Management of Medical Patients in the Intensive Care Unit in a Resource-Poor Setting in Southern Nigeria

Abstract

Purpose: The Intensive Care Unit (ICU) is a specialist ward within a hospital, with a concentration of expertise and resources for the management of critically ill patients. Some clinicians think of the ICU only in relation to surgical practice, maybe because many intensivists are anaesthesiologists and anaesthesia is closely linked to surgery. However, this notion may not be entirely true. This study aims to highlight the importance of the ICU to patients with medical challenges.
 Methodology: This is a ten-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. All patients who were admitted into the ICU with medical diagnosis were included in this study. The information gotten includes history, age, sex, diagnosis, length of admission, and outcome. The data collected was analyzed and presented in tables and charts.
 Findings: The mean age was 51.41±20.12. The highest age was 95 years. The mean bill paid was 80,718.55 Naira and the largest bill paid was 605,500 Naira while the least bill paid was 2000. The mean duration of stay was 6.59 days and ranged from a day to 120 days. The males were 268 (51.8%) while the females were 249(48.2%). Two hundred and sixty-five patients (51.3%) died during the study period. Patients who were transferred out of the ICU spent the highest amount of money and spent the most time (10.19 days) in the ICU. The patient who died spent the least amount of time (4.56 days) in the ICU. A hundred and two patients were discharged from the ICU. Transferring them to a high dependency unit or ward will save cost. As the age increased, the comorbidities also increased with 309 out of 517 having comorbidities. Exacerbation of comorbidity led to admission in the ICU.
 Recommendation: Medical patients admitted into the ICU tend to have a higher mean age and have a higher mortality rate. Older patients tend to have more comorbidity. Proper and effective management of the ICU will save cost. Proper management of comorbidities in older patients can lead to an improvement in health. Patients who are fit, could be transferred to other wards and discharged from there, this will free up beds in the ICU, increase effective use of the ICU and save cost.

Comparison Between Medical and Surgical Intensive Care Unit-A Ten-Year Review of The Management of Patients in A Resource-Poor Setting in The Niger-Delta Region of Nigeria.

“…[13][14][15][16][17] The increased awareness and use of the ICU during difficult post-operative care may and the increased usage of the ICU for obstetric complications may account for this difference. 1,14,16 In Africa and other developing economies of the world, mortality is still very high in critically ill patients due to the late presentation of patients, unavailability of well-trained staff, and lack of organ support equipment. 23 The current brain drain in Africa may also have an impact on the outcome of ICU admissions and healthcare delivery in general.…”

“…An Intensive care unit is a specialized unit in the hospital that cares for patients with lifethreatening ailments, who require close supervision and support to ensure normal homeostasis. 1,2 ICU admission is indicated for patients with potentially recoverable conditions. 3,4 The management of patients in the ICU requires 24-hour coverage by skilled multidisciplinary medical professionals.…”

“…5,6 This cost is even worse when the patient pays out of pocket. 1,2,6 The appropriate utilization of ICU beds is essential but poses a complex challenge to attain. 5 Patients who receive critical care can broadly be subdivided into medical and surgical patients.…”

“…7,8,9,10,11 Surgical intensive care patients are usually in a critical state because of perioperative critical events and some have had some form of trauma. 1 There seems to be an increase in surgical ICU patients because of innovations in surgery and better surgical techniques. 12 The Medical ICU is associated with worsening co-morbidities requiring one or more organ support.…”

“…12 The Medical ICU is associated with worsening co-morbidities requiring one or more organ support. 2 Although, studies about the ICU have been conducted in Nigeria, and South Nigeria, 1,2,13-18 there seems to be a paucity of literature comparing the challenges and outcomes of surgical and medical ICUs in the Niger Delta region of Nigeria. We, therefore, compare the outcome of patients admitted to the ICU with Medical and Surgical diagnoses.…”