Surgical admissions to intensive therapy unit at Mater Dei Hospital : a prospective 3 month study

Abstract

Introduction: Patient care in an acute hospital is divided into 4 levels, with level 0 being least demanding and level 3 comprising intensive care. A surgical high dependency unit (HDU) offers level 2 (intermediate) care and is indispensable when escalating or de-escalating from lower or higher levels of care respectively. Mater Dei Hospital lacks such a unit. --

Methods: Data was prospectively collected over a 3-month period and included all surgical patients admitted to the intensive therapy unit (ITU), including subspecialties. The duration and reasons for admission to hospital and ITU were documented. Hospital admissions were either planned or emergency. Reasons for ITU admission were either planned or unplanned after elective surgery, following emergency surgery, directly from the Emergency Department or following clinical deterioration in a level 0 ward. Number of organs supported, any surgical interventions during admission and the final outcome were noted. --

Results: There were 173 surgical patients admitted to ITU (116 males) with mean age 61.2 years. Most were post-surgery (71.7%, n=124) or after being stabilised at the Emergency Department (21.4%, n=37). Fewer required escalation from normal ward-based care (6.94%, n=12). Transfers from other hospitals occupied 3 ITU beds (1.73%). Mean ITU stay was 3.4 days per patient, with 6.5 beds being occupied by surgical cases on a daily basis. Forty-one percent of patients met the criteria for HDU. --

Conclusion: With an ever growing population, there is a need to set up a local surgical HDU. This will help relieve the recurrent shortage of ITU beds without compromising the level of healthcare delivered.