Abstract
Background
The difference between the level of care available on general ward areas and intensive care units (ICUs) has resulted in the development of high dependency units (HDUs).
Aims
This study examined the current perioperative management techniques and clinical care settings of high-risk surgical patients in a hospital without a HDU.
Methods
A prospective audit of high-risk surgical patients was performed over an eight-week period. Using a pre-operative questionnaire, the anaesthetist categorised patient suitability for one of three post-operative care areas. In addition, desired and actual post-operative monitoring, pain management and organ support were indicated.
Results
Seven (25%) of 28 patients admitted to ICU were rated HDU suitable indicating inappropriate use of resources, while 27 (75%) of 36 patients admitted to the general ward were categorised as fulfilling HDU admission criteria. A total of 21/27 (78%) and 12/27 (44%) of this latter group had alteration of idealised post-operative pain management and haemodynamic invasive monitoring plans respectively.
Conclusions
The absence of an intermediate care area facility in a tertiary hospital without an acute pain team impacts on the type of perioperative care provided to patients and the optimal use of resources.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ridley SA. Intermediate care, possibilities, requirements and solutions.Anaesthesia 1998; 53: 654–64.
Bodenham AR, Klein H. High dependency units: role and need.Br J Hosp Med 1996; 56: 192–3.
Peacock JE, Edbrooke DL. Rationing intensive care. Data from one high dependency unit supports their effectiveness.BMJ 1995; 310: 1413.
Franklin CM, Rackow EC, Mamdani B et al. Decreases in mortality on a large urban medical service by facilitating access to critical care.Arch Inter Med 1988; 148: 1403–5.
Leeson-Payne CG, Aitkenhead AR. A prospective study to assess the demand for a high dependency unit.Anaesthesia 1995; 50: 383–7.
Ryan DW, Bayly PJ, Weldon OG, Jingree M. A prospective two-month audit of the lack of provision of a high dependency unit and its impact on intensive care.Anaesthesia 1997; 52: 265–70.
Morrow BC, Lavery GG, Blackwood BM et al. The provision of adult intensive care in Northern Ireland with reference to the role of high dependency care.Ulster Med J 1996; 65: 39–46.
Singer M, Myers S, Hall G, Cohen SL, Armstrong RF. The cost of intensive care: a comparison of one unit between 1988 and 1991.Intensive Care Med 1994; 20: 542–9.
Edbrooke DL, Stevens VG, Hibbert CL et al. High dependency units in England — the lack of provision and the cost of the shortfall.Care of the Critically Ill 1997; 13: 112–5.
Stoddart JC. National ITU audit 1992/1993. London. Royal College of Anaesthetists, 1994.
Irish Standing Committee National Survey of Intensive Care Units. London: Association of Anaesthetists of Great Britain & Ireland, 1994.
Lyons RA, Wareham K, Hutchings HA, Major E, Ferguson B. Population requirement for adult critical-care beds: a prospective quantitative and qualitative study.Lancet 2000; 355: 595–8.
Colbert SA, Marsh B, Phelan D. Evaluating the feasibility of establishing a high dependency unit and its impact on intensive care.Clinician in Management 2001; 10: 73–80.
Gamil M, Fanning A. The first 24 hours after surgery. A study of complications after 2,153 consecutive operations.Anaesthesia 1991; 46: 712–5.
McQuillan P, Pilkington S, Allan A et al. Confidential enquiry into quality of care before admission to intensive care.BMJ 1998; 316: 1853–8.
Boots R, Lipman J. High dependency units: Issues to consider in their planning.Anaesth Intensive Care 2002; 30: 358–54.
Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome.Br J Anaesth 2001; 87: 62–72.
Rodgers A, Walker N, Schug S et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials.Br Med J 2000; 321: 1493.
Pain after Surgery; Report of the Working Party. London: Royal College of Anaesthetists, 1990.
Norris EJ, Beattie C, Perler B et al. Double-masked, randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery.Anesthesiology 2001; 95: 1054–67.
Webster NR. The anaesthetist as perioperative physician.Anaesthesia 2000; 55: 839–40.
Turner M, McFarlane HJ, Krukowski ZH. Prospective study of high dependency care requirements and provision.J R Coll Surg Edinb 1999; 44: 19–23.
Jones HJ, Coggins R, Lamente J, de Cossart L. Value of a surgical highdependency unit.Br J Surg 1999; 86: 1578–82.
Report of the National Confidential Enquiry into Perioperative Deaths 1998/9. London: National Confidential Enquiry into Perioperative Deaths, 2000.
Stress in Anaesthetists. London: Association of Anaesthetists of Great Britain & Ireland, 1997.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Loughrey, J.P.R., Fitzpatrick, G., Connolly, J. et al. High dependency care: impact of lack of facilities for high-risk surgical patients. Ir J Med Sci 171, 211–215 (2002). https://doi.org/10.1007/BF03170283
Issue Date:
DOI: https://doi.org/10.1007/BF03170283