Multidisciplinary intensive care in Bloemfontein, 1981-1984

From 1981 to 1984, 1,720 patients requiring critical care were admitted to two multidisciplinary intensive care units (MDICUs) run by a department of critical care at the University of the Orange Free State, Bloemfontein. The majority (61%) were referred from outside the metropolitan area. The most important referring specialties were surgery (25%), medicine (19%), orthopaedics (14%), paediatrics (10%) and obstetrics and gynaecology (9%). Almost 50 of patients stayed in unit for 1-4 days while 12% remained for more than 14 days. Average in-unit mortality (IUM) over the 4 years was 27%. The highest annual rate was 38%, but without measurement of severity of illness yearly and unit IUM figures cannot be compared. IUM for patients who remained in the unit for 1 day only (66%) was higher than that for patients remaining for more than 2 weeks (28%). Consultant and resident cover over the 4-year period was problematic and sometimes inadequate. Care by the referring doctor was impractical and limited numbers of patients in each discipline make independent 'level-1' units (ICU doctor in unit at all times) undesirable. The cost of care of the 1,720 patients over 4 years was approximately R5 700,000. Demand for MDICU care increased by 40% from 1981 to 1984.