A review of 2000 consecutive ICU admissions

The working practices and outcomes from UK intensive care units are poorly documented to date. We have reviewed 2000 consecutive admissions to one intensive care unit in a tertiary referral centre with initially six, then eight beds. The study was a retrospective review of contemporaneous data collection within the period 1986-1990. Demographic details, referral source, admission time, admission diagnosis, APACHE II score, therapeutic interventions, and outcome were recorded. A high overall mortality in the intensive care unit (23%), proportional to APACHE II scoring on admission, was demonstrated. This reflects the referral of many patients who have, or who develop, multiple organ failure. Mortality was significantly higher in patients over the age of 40 years. A total of 69.5% of patients were admitted outside the hours 0800-1800 h on Monday to Friday and admissions peaked between 1200 and 2100 h, demonstrating the need for senior out-of-hours cover. These figures may be used to compare future mortality and work practices in this and other units. The report illustrates some of the advantages and disadvantages of one method of data collection. As it represents one unit only, care must be taken in extrapolating results to others. The timing of admissions suggests that a review of medical staffing practices would be useful.