Intensive Care Unit Bed-days Research Articles

Clinical pathways in acoustic tumor management.

Clinical pathways are tools for cost containment and quality improvement in the managed care environment. This report describes our experience with developing and implementing a clinical pathway for acoustic neuroma surgery. Intensive care unit bed days and inpatient hospitalization days for cerebellopontine angle surgery significantly decreased during the months that the pathway was developed, and the incidence of complications was unchanged after adoption of the algorithm. We conclude that with joint neurootology and neurosurgery leadership clinical pathways can be a safe, cost-effective, and clinically useful technique in acoustic neuroma surgery in a managed care setting. As this management scheme evolves, surgeons must take the leadership to ensure that decisions are based on clinically relevant parameters.

Survival and quality of life in patients with protracted recovery from cardiac surgery. Can we predict poor outcome?

Of all the 2256 adult cardiac surgical patients operated upon during a 12-month period from 1st February 1992 in three units, only 162 (7.2%) spent more than 48 h in the intensive care unit (ICU) (median 6 days, range 3-90). There were 47 deaths in ICU, 7 more before hospital discharge, and a further 10 before the study end-point of one year after surgery. All 98 1-year survivors were at home with 86 of them reporting their quality of life, on formal evaluation, to be within the reference range which we have established for a less complicated cohort of cardiac surgical patients. Prospectively collected physiological measurements were used in a mathematical model to test how well we could predict which patients will die and which of the survivors have a poor quality of life. The algorithm performs well for cardiac surgery patients with a specificity of 98%. If treatment had been withdrawn when death or poor quality of life became predictable, the maximum number of ICU bed days that could be freed was of the order of 2%. The plight of these patients is distressing, but most survive and do well and they are infrequent compared with the large majority who survive to leave hospital after a short ICU stay.

Experience with 732 acute overdose patients admitted to an intensive care unit over six years.

To determine the outcome in patients with acute overdose requiring admission to the Intensive Care Unit (ICU). Prospective survey of all overdose admissions to an ICU over a six-year period ending January 1991. Tertiary referral adult teaching hospital. 732 consecutive patients with acute overdose. Death rate, use and duration of mechanical ventilation, type of compound taken and compounds associated with a fatal outcome. The 732 patients represented 13.8% of all admissions and 6% of the available ICU bed-days. Comparison with all admissions to the Emergency Department for acute overdose over a 27-month period ending April 1990 indicated that 22% of these patients were admitted to the ICU. Among the patients admitted to the ICU, tricyclic antidepressants, benzodiazepines and alcohol were the most frequently used compounds. More than one compound had been taken by 46.8% of the patients. Mechanical ventilation was required in 79.5% of the patients and 14 (2%) died. Acute overdose is a common cause of admission to the ICU but has a mortality rate of only 2%. In contrast to the overdoses taken by survivors, patients taking fatal overdoses are more likely to have taken a large dose of a single drug, or a non-medicinal compound.

An analysis of the utilisation of an intensive care unit.

We monitored the response to intensive care of 480 patients by calculating the difference in their organ failure score on the day of admission and that on the day of discharge, and related the response to hospital outcome. The patients were classified into: A) those who benefited (33%), B) those who might have benefited (28%), C) those who would never or would no longer have benefited (18%) and D) those who did not require intensive care management (21%). The criteria used were response to therapy, individually predicted outcome, hospital outcome and perceived need for intensive care. Group C patients used up 26.8% of the total intensive care unit bed days, while group D patients occupied 3.7%. We concluded that an acute terminal care unit to care for group C patients who have no hope of survival is more appropriate to the needs of our hospital than an intermediate care unit for overnight monitoring of uncomplicated postoperative and non-operative patients (group D).