37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3)

Abstract

J McCartney, A MacKay, S Binning, C Wright Queen Elizabeth University Hospital, Glasgow, United Kingdom Introduction The Queen Elizabeth University Hospital opened in May 2015. The medical high dependency unit (MHDU) opened on 15/06/2015 – it predominantly provides level 2 care for medical patients, however multi-organ support (out with invasive mechanical ventilation and renal replacement therapy) can also be provided within MHDU if appropriate. The MHDU was run initially as an “open model” with admissions through on-call medical teams and their subsequent medical care being the admitting team’s responsibility. From 05/01/16 this system changed with a critical care consultant being based within the unit during the hours of 0800 -1800, Monday- Friday, their responsibility was to provide overall supervision of care, assess the appropriateness of admissions, and provide ongoing education and support for nursing and medical staff. The aim of this study was to evaluate the impact of this intervention on unit activity, outcomes, and quality metrics. Methods Retrospective, observational cohort study for purposes of service review. Local critical care database interrogated. Data on unit activity, unit outcomes, and quality metrics collected and period pre (15/06/15-04/01/16) and post (05/01/16-26/07/16) intervention compared by univariate analysis using MedCalc to detect significant changes following intervention. Results Post intervention there was a significant decrease in out of hours discharges (OOHDC) (pre 13%, post 6.7%, p = =2 (pre 63.8%, post 76.1%, p = <0.01). There was no significant change in unit mortality rate (pre 7.5%, post 9.7%, p = 0.18), readmission rate (pre 4%, post 5.2%, p = 0.35), rate of requirement for escalation to ICU (pre 7%, post 7.3%, p = 0.89), or median length of stay (pre 1.9 days, post 1.9 days, p = 0.87). Conclusions In our cohort, regular critical care input into MHDU was associated with a decrease in OOHDC rate and an increase in days spent at level 2 dependency or higher. The reduction in OOHDC was a desirable outcome given the association between OOHCDC and excess morbidity in critically ill patients. The increase in days at level 2 or higher dependency suggests a more appropriate use of the resource, it may also be suggestive of a sicker cohort of patients, it is interesting to note that there was no significant increase in unit mortality associated with this. We believe that regular input from clinicians with critical care training is beneficial in the MHDU.