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Items 1 - 5 of 5 |
One page. |
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Metropolitan audit of appropriate referrals refused admission to intensive care.
Duke GJ.
Australian and New Zealand Intensive Care Society (Victorian Region), Carlton, Victoria.
We undertook a three-month prospective cohort study of critically ill adult patients referred to the Intensive Care Units (ICUs) of public hospitals in metropolitan Melbourne and Geelong, Victoria. The aim was to ascertain the prevalence and immediate consequences of "refused" admission amongst patients appropriately referred to the ICU of first choice. Between August 1 and October 31, 1999, 10 (out of 12) public hospitals collected data. Three thousand and four patients were referred to these ICUs, and "refusals" were reported by all hospitals. A total of 282 (9.4%) patients were unable to be admitted to the ICU of first choice, giving a rate of 3.1 "refusals" per day. The reasons for "refusal" were limited staffing (52%) and shortage of beds (46%.) Acute inter-hospital transfer (1.7 per day) was the most common immediate triage outcome (57%). These rates are higher than previously reported figures. We conclude that refused admission to the ICU of first choice, and acute inter-hospital transfer in this region and time period, were common events.
PMID: 15535499 [PubMed - in process]
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Night-shift discharge from intensive care unit increases the mortality-risk of ICU survivors.
Duke GJ, Green JV, Briedis JH.
Intensive Care Department, The Northern Hospital, Epping, Victoria.
Intensive Care (ICU) survivors discharged from ICU to the general ward at night have a higher mortality. We sought to clarify which factors, including night-shift discharge, influence outcome following ICU discharge in a metropolitan hospital, using a cohort study of critically-ill patients between 1/1/1999-30/4/2003. Patients were excluded from analysis if they (a) died in ICU, (b) were transferred to another hospital, (c) had an ICU length of stay <8 hours, or (d) age <16 years. Logistic regression was used to derive a predictive model based on the following variables: patient demographics, severity of illness following ICU admission (APACHE II mortality-risk, p(m)), final diagnosis, discharge timing including premature or delayed (>4 hours) ICU discharge, and "limitation of medical treatment" orders. The outcome measures were patient status at hospital discharge and ICU readmission rate. Of the 1870 ICU survivors, 92 (4.9%) died after discharge from ICU. Patients discharged to the ward during the night-shift (2200-0730 hours) had a higher APACHE II score and crude mortality. The difference in APACHE II p(m) did not reach statistical significance. No significant calendar or seasonal pattern was identified. Logistic regression identified night-shift discharge (RR=1.7; 95% CI 1.03-2.9; P=0.03), limited medical treatment order (RR=5.1; 95% CI 2.2-12) and admission APACHE II p(m) (RR=3.3; 95% CI 1.3-7.6) as independent predictors of patient outcome following ICU transfer to the ward. Conclusion: At the time of ICU discharge to the ward three factors are predictive of hospital outcome: timing of ICU discharge, limited medical treatment orders and initial illness severity.
PMID: 15535498 [PubMed - in process]
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The use of end-tidal carbon dioxide monitoring to confirm endotracheal tube placement in adult and paediatric intensive care units in Australia and New Zealand.
Erasmus PD.
Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia.
The use of end-tidal carbon dioxide monitoring to assist in confirming endotracheal tube placement is currently not mandatory in intensive care units (ICUs) in Australia and New Zealand. Early detection of failed tracheal intubation is vital to optimize management and to prevent complications. Questionnaires were sent to the lead clinician/head of department of all 66 intensive care units approved for training purposes by the Joint Faculty of Intensive Care Medicine in Australia and New Zealand. The methods used to confirm correct endotracheal tube placement, the availability of end-tidal carbon dioxide monitoring and its role in confirming endotracheal tube placement in the intensive care unit were explored. Completed questionnaires were received from 61 of the 66 centres (92.4%). Wide variation in the method of confirmation of endotracheal tube position was demonstrated, with 23 (37.7%) of units using sub-optimal methods. Sixty (98.3%) of units had end-tidal carbon dioxide monitoring available. Thirty-eight (62%) units shared monitors between several beds; and 22 (36%) had one monitor per bed. End-tidal carbon dioxide monitoring was used routinely to confirm endotracheal tube placement in 42 (68.8%) units. Fifty-two respondents (83.3%) felt that end-tidal carbon dioxide monitoring was superior to other methods for confirming endotracheal tube placement in critically ill patients. Thirty-eight respondents (62.3%) thought that end-tidal carbon dioxide monitoring should be mandatory to confirm tracheal intubation in the intensive care unit. If it were available, 42 respondents (68.8%) would use end-tidal carbon dioxide monitoring for confirmation of every intubation. Mandatory end-tidal carbon dioxide confirmation of endotracheal tube placement was policy in 33 (54.1%) of the intensive care units.
PMID: 15535493 [PubMed - in process]
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Nasopharyngeal oxygen in adult intensive care--lower flows and increased comfort.
Eastwood GM, Reeves JH, Cowie BS.
Epworth Hospital Intensive Care Unit, Richmond, Victoria.
Nasopharyngeal oxygen therapy, the delivery of supplementary oxygen into the nasopharynx via a fine catheter placed through the nose, is a simple technique used in postoperative anaesthetic care units and paediatric intensive care, but never described in the setting of adult intensive care. In a prospective crossover design, we compared nasopharyngeal oxygen therapy with semi-rigid plastic mask (Hudson Mask) in 50 unintubated adult patients receiving supplemental oxygen. We measured oxygen flow rate to achieve cutaneous saturations 93 to 96%, and patient comfort by visual analogue score. Nasopharyngeal oxygen therapy consumed significantly less oxygen than mask administration (3.0+/-0.9 vs 6.7+/-2.1 l/min, P<0.001) and was associated with significantly higher comfort than the mask (7.5+/-1.6 cm vs 5.2+/-1.8, P<0.001).
PMID: 15535492 [PubMed - in process]
Hospital discharge to care facility: a patient-centered outcome for the evaluation of intensive care for octogenarians.
Rady MY, Johnson DJ.
Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054.
INTRODUCTION: Hospital survival and length of stay are commonly used for the evaluation of intensive care outcome for the young and octogenarian patients (>/= 80 years old).Hypothesis: Hospital discharge to a care facility should be considered for more accurate evaluation of intensive care outcome, especially for octogenarian patients. DESIGN: An observational descriptive study. PATIENTS: A total of 6,154 consecutive hospital admissions requiring intensive care over 4 years. MEASUREMENTS: Demographics, preadmission comorbidities, severity of illness, acute hospital diagnosis categories, charges and destination after discharge, and postdischarge survival for up to 42 months. RESULTS: Octogenarians represented 15% of intensive care admissions (900 admissions). The interventions performed in the ICU, the severity of illness measured by sequential organ failure assessment (SOFA), and hospital length of stay were similar for octogenarian and younger patients. Octogenarians had higher hospital mortality (10% vs 6%, p < 0.01) and discharge to care facility (35% vs 18%, p < 0.01) than younger patients. The average hospital charge per octogenarian hospital survivor discharged to home was $128,000, compared to $100,000 for a younger hospital survivor. At follow-up, octogenarian hospital survivors who were discharged to a care facility had higher mortality than hospital survivors discharged to home (31% vs 17%, p < 0.01). On multiple logistic regression, older age, female gender, preadmission comorbidities, type of admission, SOFA score >/= 4, mechanical ventilation >/= 96 h, requirement for tracheotomy, and hospital diagnosis categories were independent factors for discharge of hospital survivors to a care facility. CONCLUSIONS: Hospital survival and length of stay did not accurately measure intensive care outcome for octogenarians. Care dependency among octogenarians who survived intensive care was prevalent and decreased their long-term survival. Care dependency and functional disability among hospital survivors should be considered for more accurate evaluation of intensive care outcome in that age group.
PMID: 15539731 [PubMed - in process]
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