Dr. Tsang Chi Chung, Intensive Care Unit, Department of Medicine, North District Hospital
Abstract
Objective: The aim of this study was to evaluate the incidence and characteristics of serious clinical antecedents, abnormal physiological values and interventions occurred in patients in general wards in the 24 hours prior to admission to intensive care unit.
Setting: North District Hospital, Fanling, the New Territories, Hong Kong.
Methods: Data of a total of 105-patient admissions to the ICU from the general wards of a local acute-care hospital in the year 2002 was analyzed retrospectively. Serious clinical antecedents and abnormal physiological variables occurred as well as interventions offered in wards were recorded.
Results: A great percentage of patients (87.6%) had clinical antecedents during the 24 hours’ period before their transfer to ICU and 44.8% patients had clinical antecedents in 12 to 24 hours prior to their admission. Eighty-three patients (79%) had more than one antecedents in the general wards. The most common antecedents documented during the 24 hours before admission were respiratory distress (n=85), hypoxia (n=73), tachypnea (n=35), hypotension (n=33) and tachycardia (n=31). Patients with respiratory distress (P=0.039), hypoxia (P<0.01), bradycardia (P=0.028) or hypotension (P<0.01) died more frequently during their ICU care compared with those without these clinical antecedents. Fifty seven patients (54.3%) had interventions received in wards in the 24 hours before ICU admission. The most common interventions offered were endotracheal intubation (n=42) and non-invasive positive pressure ventilation (n=31). A greater percentage of medical patients were ventilated with non-invasive positive pressure ventilation in general wards (P<0.01) compared with non-medial patients. Patients with clinical antecedents (P <0.01) or interventions (P=0.029) in general wards had longer ICU care.
Conclusion: Patients admitted from general wards were frequently found to have potentially life-threatening clinical antecedents and abnormal physiological values as well as invasive interventions. Information collected on the wards identified seriously ill patients who may have benefited from earlier expert management.