SESSION TITLE: Quality Improvement in the ICU I
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM
PURPOSE: Unplanned ICU admissions are associated with increased morbidity and mortality.The aim of this study was to analyze patterns and outcomes of unplanned Intensive care admissions in a tertiary care hospital.
METHODS: A retrospective study was conducted focusing on ICU admissions between January 1st and December 31st of 2011. Patients who were transferred to intensive care unit from general medical floors within 48 hours of admission were included in the study. Patients whose admission did not originate in emergency department were excluded. Data were collected from charts and statistical analysis performed using SPSS version 16. Categorical variables were summarized using frequencies and compared with chi-squared testing, with P value <0.05 considered statistically significant.
RESULTS: There were 657 ICU admissions between January 1st and December 31st of 2011. 54 patients (8.2%) met the criteria to be included in the study with a mean age of 66.8.Mean APACHE II score was 17.8.The three most common initial diagnoses on admission were pneumonia (20.4%), COPD (7.6 %) and gastro-intestinal bleeding (7.4%). Patients stayed in Emergency room for an average of 6 hours prior to admission. None of these patients had critical care evaluations called for in the ED. The most common diagnosis requiring ICU admission were severe sepsis or septic shock (35%), respiratory failure (32%), submassive PE (5.6%), and massive GI bleed (5.6%).23 patients (42%) met the criteria for SIRS/ sepsis at presentation to the ED. Overall in -hospital mortality rate was 33% and there was significant association between in patient mortality and diagnosis of severe sepsis/septic shock (p<0.001).
CONCLUSIONS: Our hospital mortality rate of patients with severe sepsis/septic shock triaged in the ED to the regional floor after initial response to fluid resuscitation is 16%. Patients with unplanned admission to the ICU with the delay in diagnosis of severe sepsis have a higher mortality than those identified in the ED. Screening for severe sepsis during emergency room triage can prevent such delays in diagnosis and may decrease mortality.
CLINICAL IMPLICATIONS: Our data supports the early recognition of sepsis initiative.
DISCLOSURE: The following authors have nothing to disclose: Benyam Alemu, Zakaria Majeed, Linda Kirchenbaum
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