J P R Loughrey1, G Fitzpatrick, J Connolly, M Donnelly. 1. Department of Anaesthesia and Intensive Care, Adelaide Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland. jloughrey@eircom.net
Abstract
BACKGROUND: The difference between the level of care available on general ward areas and intensive care units (ICUs) has resulted in the development of high dependency units (HDUs). AIMS: This study examined the current perioperative management techniques and clinical care settings of high-risk surgical patients in a hospital without a HDU. METHODS: A prospective audit of high-risk surgical patients was performed over an eight-week period. Using a pre-operative questionnaire, the anaesthetist categorised patient suitability for one of three post-operative care areas. In addition, desired and actual post-operative monitoring, pain management and organ support were indicated. RESULTS: Seven (25%) of 28 patients admitted to ICU were rated HDU suitable indicating inappropriate use of resources, while 27 (75%) of 36 patients admitted to the general ward were categorised as fulfilling HDU admission criteria. A total of 21/27 (78%) and 12/27 (44%) of this latter group had alteration of idealised post-operative pain management and haemodynamic invasive monitoring plans respectively. CONCLUSIONS: The absence of an intermediate care area facility in a tertiary hospital without an acute pain team impacts on the type of perioperative care provided to patients and the optimal use of resources.
BACKGROUND: The difference between the level of care available on general ward areas and intensive care units (ICUs) has resulted in the development of high dependency units (HDUs). AIMS: This study examined the current perioperative management techniques and clinical care settings of high-risk surgical patients in a hospital without a HDU. METHODS: A prospective audit of high-risk surgical patients was performed over an eight-week period. Using a pre-operative questionnaire, the anaesthetist categorised patient suitability for one of three post-operative care areas. In addition, desired and actual post-operative monitoring, pain management and organ support were indicated. RESULTS: Seven (25%) of 28 patients admitted to ICU were rated HDU suitable indicating inappropriate use of resources, while 27 (75%) of 36 patients admitted to the general ward were categorised as fulfilling HDU admission criteria. A total of 21/27 (78%) and 12/27 (44%) of this latter group had alteration of idealised post-operative pain management and haemodynamic invasive monitoring plans respectively. CONCLUSIONS: The absence of an intermediate care area facility in a tertiary hospital without an acute pain team impacts on the type of perioperative care provided to patients and the optimal use of resources.