Admission patterns, early mortality, and organisational workload in a medical intensive care unit: An eight-year...

To analyse patient admission patterns, clinical outcomes, and organisational workload in a medical intensive care unit (ICU), with emphasis on early mortality and post-pandemic changes in healthcare demand.

This retrospective, observational, single-centre cohort study included all adult patients admitted to the medical ICU of the Clinic for Internal Medicine at the University Clinical Centre Tuzla between January 1, 2018, and December 31, 2025. Aggregated data were obtained from the hospital information system and internal ICU records. Analysed variables included annual admission volume, admission sources, discharge outcomes, in-hospital and early mortality (within 24-72 hours after ICU admission), estimated length of stay, invasive procedures, and patient age. Temporal trends were assessed across pre-pandemic (2018-2019), pandemic (2020-2021), and post-pandemic (2022-2025) periods.

A total of 9,342 ICU hospitalisations were analysed. Admissions remained relatively stable through 2020, declined in 2021, reached their lowest level in 2022, and then increased markedly from 2023 onward. Admissions per bed rose from 67.5 in 2022 to 108.6 in 2025, while the estimated mean ICU length of stay decreased from 5.4 to 3.4 days. Overall, in-hospital mortality was approximately 22%, with 75-80% of deaths occurring between 24 and 72 hours from admission. The patient population was predominantly elderly, with a mean age of approximately 70 years.

Medical ICU services operated under increasing organisational strain, reflected by rising admission volume, higher admissions per bed, and reduced estimated length of stay despite fixed bed capacity. Persistently high early mortality remained a prominent feature of this population.