- Poster presentation
- Open Access
Organisational changes in service provision outside critical care impact on referral patterns
Critical Care volume 18, Article number: P8 (2014)
Demand for critical care (CC) resources is constantly increasing in the face of limited availability. Guidance for triage exists but may no longer reflect current practice [1, 2]. We previously identified nonmedical and medical factors (comorbidities, physiological derangement and functional status) as predicting likelihood of admission of referred patients to CC [3–5]. Reduction in UK doctors' working hours and numbers has resulted in new ways of multidisciplinary teams working the hospital at night (H@N), which may have an impact on CC referral. We aimed to establish any effect ofhospital changes in service provision outside CC on the referral pattern and admissions.
Data from prospectively enrolled urgent patient referrals were analysed comparing two periods: before (period 1: 2011/12) and after (period 2: 2013) the introduction of H@N. We collected data on acute physiological parameters, hospital length of stay, demographic and functional status, dependency and comorbidities. STATA was used for these preliminary analyses.
Comparing the two periods we found no significant differences in age, gender distribution, degree of acute physiological derangement, comorbidities, specialty of origin, time spent in hospital prior to referral and grade of referrer. By contrast, the proportion of out- of-hours referrals greatly increased (from 49.3% to 69.7%) along with the proportion of referrals deemed inappropriate for CC (from 37.3% to 54.8%); the proportion of patients accepted increased only marginally (from 46.7 to 50%) in the second period, compared with the first. Neither the number of beds available within the critical care department (P = 0.59) nor receiving the referral out of hours (P = 0.8) influenced the likelihood of admission. The factors predicting admission to CC (functional status, acute physiological derangement) did not differ significantly between the two periods examined. Housebound status was consistently found to be an independent predictor of admission refusal (OR 0.11, 95% CI 0.05 to 0.23, P < 0.001).
Decision-making about admission to CC is based mainly on the assessment of patients' functional status. Organisational changes in the provision of healthcare services outside CC, such as H@N, have had a significant influence on CC workload and patterns of referrals.
ACCCM Guidelines for ICU admission, discharge, and triage Crit Care Med 1999, 27: 633-638. 10.1097/00003246-199903000-00048
ATS. Fair allocation of intensive care unit resources Am J Respir Crit Care Med 1997, 156: 1282-1301.
Tridente A, Chick A, Keep S, Furmanova S, Webber S, Bryden DC: Factors affecting critical care admission to a UK University Hospital [Poster P508]. In 32nd International Symposium on Intensive Care and Emergency Medicine. Brussels; 2012. March 19-23
Tridente A, Chick A, Keep S, Furmanova S, Webber S, Bryden DC: Functional status as a predictor of admission to critical care in acutely unwell patients [Abstract 0424]. In 25th Annual Congress of the European Society of Intensive Care Medicine. Lisbon; 2012. October 13-17
Tridente A, Chick A, Keep S, Furmanova S, Webber S, Bryden DC: Non medical factors influence likelihood of admission to critical care of acutely unwell patients [Abstract A-570-0025-00363]. In 26th Annual Congress of the European Society of Intensive Care Medicine. Paris; 2013. October5–7
About this article
Cite this article
Tridente, A., Cecchini, L., Lobaz, S. et al. Organisational changes in service provision outside critical care impact on referral patterns. Crit Care 18, P8 (2014). https://doi.org/10.1186/cc13198
- Functional Status
- Critical Care
- Service Provision
- Healthcare Service
- Multidisciplinary Team