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15. article audit  icu ccu
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15. article audit icu ccu

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  • 1. Audit of the Patients Admitted in Critical Care Units of BPKIHS Mehta*1 RS, Karki*2 P, Bhattari*3 BK, Rai*4 I, Shrestha*5 L. B.P. Koirala Institute of Health Sciences, Nepal Email: ramsharanmehta@hotmail.comAbstract:Introduction: Most hospitalized patients with critical conditions are cared for in critical careunit patient care areas designed to provide extraordinary treatment by specially trained healthcareprofessionals, often with the use of high-tech equipment. B.P. Koirala Institute of HealthSciences has a 700 bedded tertiary care center hospital with 8 beds ICU and 6 beds CCU withmodern facilities.Objectives: The objective of this study was to find out the demographic characteristics and thediseases pattern of the admitted patients in Intensive Care Unit and Coronary Care Unit (ICU &CCU) of BP Koirala Institute of Health Sciences.Methodology: It was a hospital based retrospective descriptive study design, conducted amongthe admitted patients of ICU and CCU from 14th April 2009 to 13th March 2010 (2066 BS). Thetotal number of patients admitted in critical care units during the study period constituted thepopulation of the study. Systemic random sampling technique was used to collect the data usingthe prepared Performa from the admission register of the ward. The data was collected from theadmission register from 1-7-2010 to 7-7-2010. Total 120 patients were included in the study outof total admitted 601 patients using stratified systemic random sampling technique.Results: During the study period in ICU total 269 patients were admitted, 91 transferred out, 63referred, 61 expired, 37 left against medical advice (LAMA), and 17 was still on bed; similarlyin CCU total 346 patients were admitted, 211 were transferred out, 19 discharged, 55 referred, 38expired and 30 LAMA. Most of the patients admitted were of age 20-60 years, from Sunsari(42.1%), Morang (18.2%), and Jhapa (14.9%) district, with mean duration of stay 7.47 days andmale, female ratio is nearly equal. The major diagnosis for ICU admission was complication ofexploratory laboratory (11.5%), OPP (11.5%), encephalitis (7.7%), and multi-organ failure(5.8%), similarly the major diagnosis for CCU admission was acute coronary syndrome (21.7%),myocardial infraction (MI) (18.8%), Shock (8.7%), and RHD (7.2%).Conclusions: The number of admission in ICU/CCU is increasing as the bed strength, patientsload and complexity of cases increasing; hence the necessary management in ICU/CCU ismandatory to overcome the future problems. The diagnosis of patients admitted in the unit iscomplicated and prognosis is also not very satisfactory, hence exploratory study is essential.Key Words: Demographic Profile, Outcomes, Critical CareAuthors: *1 Ram Sharan Mehta, Associate Professor, Medical-Surgical Nursing Department, *2 Prof. PrahladKarki, HOD, Department of Internal Medicine, *3Prof. Dr. Balkrishna Bhattari, Dept. of Anesthsiology andCritical Care, *4Ms. Indira Rai, Nursing In-charage, ICU/CCU unit, *5Ms Laxmi Shrestha, ICU Nurse. 1
  • 2. Introduction: An intensive care unit (ICU) is a specialized section of a hospital that providescomprehensive and continuous care for persons who are critically ill and who can benefit from treatment.The purpose of the intensive care unit is simple even though the practice is complex. Healthcareprofessionals who work in the ICU or rotate through it during their training provide around the clock,intensive monitoring and treatment of patients seven days a week. 1Patients cared for in ICUs include those with severe trauma, major head injury or coma, respiratory and/orhemodynamic insufficiency, or failure of one or more organ systems and those with intensive monitoringneeds following major surgery. The medical needs of ICU patients are often complex, requiring ofcaregivers, who work under stressful conditions, a high degree of knowledge and skill. Despite thededication and competency of ICU caregivers, mortality rates for critical care patients remain high,ranging from 10% to 20%.2 The intensive visit will provide treatment management, diagnosis,interventions, and individualized care for each patient recovering from severe illness. 3Despite tremendous resource utilization, the majority of trauma patients with prolonged ICU stays caneventually return to varying degrees of functional daily living and independence, but not to preinjurylevels. A subgroup of severely injured elderly patients had a significantly higher mortality rate. However,elderly survivors that entered our rehabilitation facility fared as well as the younger patients.1The main feature of coronary care is the availability of telemetry or the continuous monitoring of thecardiac rhythm by electrocardiography. This allows early intervention with medication, cardioversion ordefibrillation, improving the prognosis. As arrhythmias are relatively common in this group, patients withmyocardial infarction or unstable angina are routinely admitted to the coronary care unit.4 Early successin CCUs with resuscitation and with the detection and treatment of arrhythmias focused researchersattention on left ventricular failure and cardiogenic shock. The Swan-Ganz flow-guided catheter wasintroduced, and its use for invasive monitoring of cardiac hemodynamic became routine in some centers. 5In hospital critical care units, many of the individual challenges confronting other hospital units intersect,making the critical care setting the most complex environment in the healthcare facility. Nursing care hasan important role in a critical care unit. The nurses role usually includes clinical assessment, diagnosis,and an individualized plan of expected treatment outcomes for each patient i.e. implementation oftreatment and patient evaluation of results.Objectives: The objective of this study was to find out the demographic characteristics and the diseasespattern of the admitted patients in Intensive Care Unit and Coronary Care Unit (ICU and CCU) of BPKoirala Institute of Health Sciences. , Dharan, Sunsari, Nepal.Methodology: It was a hospital based retrospective descriptive study design, conducted among theadmitted patients in CCU and ICU of BPKIHS using the admission register of the ward. A Performa wasprepared and the required informations were collected in the Performa form the admission register. Thetotal number of patients admitted in critical care units during the study period constituted the populationof the study. Stratified simple random sampling technique was used to collect the data using the preparedPerforma from the admission register of the ward. The data was collected from the admission registerfrom 1-7-2010 to 7-7-2010. Total 120 patients were included in the study out of total admitted 601patients using stratified systemic random sampling technique. The collected data was entered in Excel andanalyzed using SPSS-11.5 software package. The details of the findings are depicted in the tables andgraphs.Results: During the study period, in ICU total 269 patients were admitted, 91 transferred out, 63referred, 61 expired, 37 LAMA, and 17 was still on bed; similarly in CCU total 346 patients were 2
  • 3. admitted, 211 were transferred out, 19 discharged, 55 referred, 38 expired and 30 LAMA. Most of thepatients admitted were of age 20-60 years, from Sunsari (42.1%), Morang (18.2%), and Jhapa (14.9%)district, with mean duration of stay 7.47 days and male, female ratio is nearly equal. The major diagnosisfor ICU admission is complication of exploratory laboratory (11.5%), organophosphorus poisoning (OPP)(11.5%), encephalitis (7.7%), and multi-organ failure (5.8%), similarly the major diagnosis for CCUadmission is acute coronary syndrome (21.7%), MI (18.8%), Shock (8.7%), and RHD (7.2%). The detailsare depicted in table 1 to 6.Discussion: Critical care unit is specialized unit in which expert medical, nursing and technical staffswere provided care with equipment for monitoring and immediate life saving intervention involved inparalleled with advance invasive surgical, medical procedures. Principles of Critical Care are: Earlydiagnosis and identification of problems, Anticipation of possible events and complication, a holisticapproach to critical illness, the considered use of technology and Recognition of the limit of critical care.Out of total 269 ICU admissions during the study period of one year, 63 patients were reported, 61expired, 37 LAMA requires the detailed investigation to explore the reasons for poor outcome. Similarfindings were reported by Yaseen6, Rosenberg7 and Weissman8.In CCU total 346 patients were admitted during the same period and among that 55 patients were referred,38 expired and 30 LAMA, require the detailed investigations to explore the reasons for poor outcome.Similar findings were reported by Praveen9 and Kanus10.Conclusions: The number of admission in ICU/CCU is increasing as the bed strength, patients load andcomplexity of cases increasing; hence the necessary management in ICU/CCU is mandatory to overcomethe future problems. The diagnosis of patients admitted in the unit is complicated and prognosis is alsonot very satisfactory, hence exploratory study is essential.Reference: 1. Miller RS, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive prolonged lengths of stay in the intensive care unit. J Trauma. 2000; 48(2):229-34. 2. Weissman C. Analyzing intensive care unit length of stay data: problems and possible solutions. Crit Care Med. 1997; 25: 1594–1600. 3. Rosenberg AL, Hofer TP, Hayward RA et al. Who bounces back? Physiologic and other predictors of intensive care unit readmission. Crit Care Med. 2001; 29: 511–518. 4. Mehta NJ, Khan IA. Cardiologys 10 greatest discoveries of the 20th century. Texas Heart Institute J. 2002; 29:164-71. 5. Julian DG. The history of coronary care units. British Heart J. 1987; 57:497–502. 6. Yaseen A, Venkatesh S, Samir H, Abdullah Al S, Salim Al M. A Prospective Study Of Prolonged Stay In The Intensive Care Unit: Predictors And Impact On Resource Utilization. International Journal For Quality In Health Care, 2002, 14:403-410 7. Rosenberg AL, Hofer TP, Hayward RA et al. Who bounces back? Physiologic and other predictors of intensive care unit readmission. Crit Care Med. 2001; 29: 511–518. 8. Weissman C. Analyzing intensive care unit length of stay data: problems and possible solutions. Crit Care Med. 1997; 25: 1594–1600. 9. Praveen K, Devajit S, Reeta S et al. Demographic Profile and outcome analysis of a tertiary level pediatric intensive care unit. 2004; 71(7): 587-591. 10. Kanus WA, Draper EA, Wagner DP et al. Compression of Frequency distribution in demonstration unit and 13 tertiary hospitals. Crit Care Med. 1985; 13: 823. 3
  • 4. Table 1 Demographic Characteristics of the Subjects Responses Total ICU CCUSN Demographic Characteristics (ICU & CCU) (n=52) (n=69) (n=121) Percentage (%) Percentage (%) Percentage (%) 1 Age Group < 20 11.5 5.8 8.3 20-40 40.4 20.3 28.9 40-60 28.9 22.1 35.5 >60 19.2 33.3 27.5 Mean 41.44 52.35 47.66 SD 19.429 19.305 20.025 Range 15-80 15-84 15-84 2 Gender a. Male 50 62.3 57 b. Female 50 37.7 43 3 Caste of the subject a. Brahmin/Chhetry 17.3 24.6 21.5 b. Mangolian (Rai, Limbu, Gurung, 26.9 29 28.1 Magar, Tamang) c. Newar 9.6 13 11.6 d. Trai Origin Caste 46.2 33.4 38.3 Table 2 Duration of stay of the subjects Responses Total ICU CCUSN Duration of Stay (ICU & CCU) (n=52) (n=69) (n=121) Percentage (%) Percentage (%) Percentage (%) 1 1-3 days 50 39.1 43.8 2 4-7 days 11.5 39.2 27.3 3 8-14 days 15.4 16 15.1 4 >14 days 23.1 5.7 13.2 Mean 8.96 6.83 7.74 SD 9.856 11.438 10.795 Range 1-43 1-89 1-89 Table 3 Major Diagnosis of the subjectsSN Diagnosis of the subject Number (%) Diagnosis of ICU admitted Patients (n=52) 1 Exploratory Laprotomy: complications 6(11.5) 2 Organ-phosphorus Poisoning 6(11.5) 3 Encephalitis 4(7.7) 4 Multi-organ Failure 3(5.8) 5 Cholecystectomy 3(5.8) 6 Stab-injury 3(5.8) 7 Others 27(52) Diagnosis of ICU admitted Patients (n=69) 1 Acute Coronary Syndrome (ACS) 15(21.7) 2 Myocardial Infraction (MI) 13(18.8) 3 Shock 6(8.7) 4 Rheumatic Heart Disease (RHD) 5(7.2) 5 Diabetic Kito-acidosis (DK) 4(5.8) 6 End Stage Renal Disease (ESRD) 3(4.3) 7 Others 23(33) 4

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