Utility of an emergency intensive care unit (EICU) in a tertiary care hospital

Background

In the past, many casualty patients needing ICU care were being refused due to nonavailability of beds. Therefore a five-bedded EICU was introduced, adjoining the Accident and Emergency Department, to offer emergency treatment for a limited period of 24 hours.

Aims

To study the utility of EICU and the effect of change in its admission policy.

Methods

EICU patients admitted over a 20-month period were analysed retrospectively. This was divided into: Phase I from July 2001 to October 2002 (16 months), during which period we accepted patients transferred in from other nursing homes as well, and Phase II from August 2003 to November 2003 (4 months), when we accepted only emergency cases coming directly to our casualty. Eight diagnostic categories were formulated as follows: infection, trauma, cardiac, central nervous system (CNS), respiratory, gastrointestinal, renal emergencies and others. Various parameters such as inotropic requirement, procedures performed and their final outcome were studied.

Results

In Phase I, we had a total of 1322 EICU patients, of whom 117 (9%) required circulatory support in the form of inotropes, 74 (6%) required ventilatory support and 118 (9%) required invasive monitoring. Two intra-aortic balloon pumps (IABPs) were inserted and no haemodialysis was done. There were 168 recent myocardial infarction (MI) patients, of whom 34 (20%) were thrombolysed. Diagnostic categories were as follows: infections 82 (6%), trauma 73 (6%), cardiac conditions: MI 168 (13%) and non-MI 473 (36%), respiratory 142 (11%), CNS 178 (13%), gastrointestinal 139 (10%), renal 42 (3%), and others 25 (2%). Of all these patients, 698 (53%) patients were transferred to the ICU, 467 (35%) to the rooms, 98 (7.5%) discharged and 59 (4.5%) expired. On the other hand, Phase II had 301 patients, of whom 43 (14%) required circulatory support, 27 (9%) required ventilatory support and 85 (20%) required invasive monitoring. Two IABPs were inserted and four patients were haemodialysed. Out of 31 recent MI patients, 16 (51%) were thrombolysed. Diagnostic categories were: infections 34 (12%), trauma 24 (8%), cardiac conditions: MI 31 (10%) and non-MI 91 (30.4%), respiratory 31 (10%), CNS 40 (13%), gastrointestinal 33 (11%), renal 15 (5%), and others two (0.6%). Of all these patients, 153 (51%) were transferred to the ICU, 103 (33%) to the rooms, 45 (15%) discharged and three (1%) expired.

Conclusion

In our study, we noted an increasing trend in the admission of more critical patients in Phase II as compared with Phase I, as shown by the increasing requirement for circulatory and ventilatory support and invasive monitoring techniques. Thus, the EICU has been helpful in providing acute emergency treatment to patients seeking it and helped stabilise them.