To decrease ICU mortality - fix pre-ICU care !!
Team from Cooper University Hospital, Camden, NJ (Raquel Nahra, MD, Christa Schorr, RN and David R. Gerber, DO) - addressed a very important and often ignored issue at ACCP meeting of november 2005 : PRE–INTENSIVE CARE UNIT LENGTH OF STAY AND OUTCOME IN CRITICALLY ILL PATIENTS 1.
Patients were divided into 4 groups:
- Group M1 - medical patients HLOS less than / = 5 days
- Group M2 - medical patients HLOS more than / = 6 days
- Group S1 - surgical patients HLOS less than / =5 but more than 1 day
- Group S2 - surgical patients HLOS more than / = 6 days
*HLOS = hospital length of stay and data was obtained from the Project Impact database.
Study found that: ICU admission from a general care floor after more than / = 6 days is associated with poor outcome(Group M2). Suboptimal care prior to ICU admission is the reason for poorer outcomes. Probable reasons:
- Poor organization,
- Insufficient knowledge,
- Failure to appreciate clinical urgency,
- Inadequate supervision and
- Failure to seek advice
Editors note: Lessons to be learned include intensivists' early involvement in care outside ICU, formation of rapid response team, close working of floor team (hospitalist) and intensivist and more inservices/training for floor staff.
Related previous pearl: Rapid Response Team
Related Sites: IHI's RRT - getting started kit and SCCM's RRT/ MET forum
Reference: click to get abstract
PRE–INTENSIVE CARE UNIT LENGTH OF STAY AND OUTCOME IN CRITICALLY ILL PATIENTS - Critical Care Outcomes, ACCP meeting November 2, 2005