Utilisation of critical care services for surgical patients in a model three hospital

Abstract

Background The demand for intensive care unit (ICU) beds in the surgical population has increased in recent years. This is due to increased complexity of operative interventions, development of critical care services and improved availability of technologies. The number of beds in ICUs nationwide remains limited. In model three hospitals, this is further impacted by a lack of high dependency unit (HDU) facilities and difficulty with transfer of patients to tertiary centres. Aim To assess utilisation of ICU resources amongst general surgical patients admitted for elective and emergency procedures to Mayo University Hospital. Methods A prospective study was conducted between 31/10/2016 and 01/11/2017 on general surgical patients admitted to the intensive care unit. The ICU register and ICU database were used to collect data regarding patient demographics, admission by specialty, ICU length of stay, interventions performed, level of care, infection status and antimicrobial usage. Results Eight hundred seventy-three patients were admitted to the ICU. One hundred thirty-four (15.35%) were surgical admissions, of which 55 were elective and 79 were emergency. The most common cause for emergency admission to ICU was emergency laparotomy. Mean ICU length of stay (LOS) for surgical patients was 3.6 days. Three (2.2%) surgical patients were transferred to model four hospitals. Conclusions This study demonstrates the need to protect sufficient numbers of ICU beds for delivery of emergency surgical care. It highlights the potential utility of an HDU in this setting. The introduction of such a facility would impact cost savings and increase access for those requiring definitive ICU level care.

Surgical Admissions and Treatment Outcomes at a Tertiary Hospital Intensive Care Unit in Ethiopia: A Two-Year Review

“…If this group of patients are excluded, the surgical ICU admission percentage of our series will be comparable with findings of smith el al (28.6%) and Onyekwulu et al (20.5%) (20,22). In our analysis and others', males and emergency surgeries made the majority of surgical ICU admissions (5,7,11,13,(15)(16)(17)24,25). This could be due the higher disease prevalence like trauma in males and lack of adequate time for preoperative optimization in emergency patients.…”

“…(22). Audits of Intensive Care Over Nations (ICON) and studies of Nepal, Jordan and Ireland parallel the finding of this study (10,11,13,21). The possible reasons for the discrepancy include variation in disease prevalence, ICU organization and availability of trained staffs.…”

“…As compared to other studies, our patients stayed longer in the ICU (11,15,22,24). There are many possible reasons for this,including difference in study subjects, presence of high dependence/intermediate unit and proper ICU admission criteria.…”

“…Recently, demand for surgical intensive care is increasing due a number of reasons such as advancement in operative procedures, improved critical care service and critical care technologies (5,(11)(12)(13).Emergency department or general wards may act as a source for ICU admissions due to deterioration of patients' clinical condition or as a postoperative case from the operating theatre. Failure to awake from anesthesia, surgeries with high risk of complication and various sequalae of procedures are among the reasons of ICU care for a surgical patient.…”

“…Failure to awake from anesthesia, surgeries with high risk of complication and various sequalae of procedures are among the reasons of ICU care for a surgical patient. ( 8 , 11 , 14 – 17 ).…”