Prospective study of high dependency care requirements and provision

To compare the level of post-operative care requested for surgical patients with that provided in a Scottish teaching hospital.

A three months pragmatic prospective observational study was undertaken which included patients undergoing major surgery excluding gynaecological and elective orthopaedic surgery. A study specific questionnaire was used to collate the information. The data were inputted to DataEase 4.5 and subsequently exported to SPSSWIN version 6.1.3 for analysis. The main outcome measure was the level of care requested and the level of care actually received.

Among 1363 patients a total of 1395 operations were performed. The median age was 59 years with a male: female ratio of 1.1:1. The type of admission was elective in 58% and emergency in 42% of cases. The operations were elective in 44% and nonelective in 56% of cases. The ASA score was 3 or greater in 33% of patients. The optimum level of care requested by surgeons and anaesthetists was intensive therapy unit (ITU) in 9.7% and high dependency unit (HDU) in 23.6% of patients. Twenty-one (15.9%) of 132 ITU requests and 256 (73.8%) of 349 HDU requests were not met immediately post-operatively. Overall mortality was 1.5%. For those patients who received optimum requested care mortality was 1.2% and, in those patients who did not receive optimum requested care, mortality was 3.1% (p < 0.038: Chi-square).

This study confirms a significant lack of access to properly staffed and equipped HDU facilities in a major teaching hospital with a consequent increase in mortality in those not receiving optimal post-operative care.