Time and type of admission to a surgical intensive care unit

Introduction

Duke University Medical Center (DUMC) is a tertiary care hospital with a Level 1 (USA) Trauma Center Designation. Increasing level of patient acuteness, high census levels, decreasing resident staffing and financial concerns have led to intensive care unit (ICU) organization and staffing changes. ICU care is being redefined at DUMC via pursuit of a multidisciplinary approach to the treatment of critically ill patients. As part of this initiative, analysis of Surgical Intensive Care Unit (SICU) admissions was performed for January through March 1998. This analysis showed that 45% of admissions occurred when there was no attending in house. To fulfill the missions of patient care, education, research, cost-containment, optimal bed utilization and appropriate reimbursement for services, we instituted around-the-clock board-certified intensivist coverage in the SICU. Continuing analysis of admission distribution confirms that half of admissions occur at night and breakdown of type of admission indicates that these admissions are the patients most requiring active resuscitation and supervision of resident management.

Methods

To determine time and type of SICU admissions we retrospectively reviewed the SICU database from July through November 1998. Time of arrival was divided into 12-h blocks beginning at 6 AM and 6 PM. Patients were divided into four categories: postoperative, direct admission, trauma and floor transfer.

Results

There are approximately 115 admissions per month to this 16 bed ICU for a total of 575 admissions for the study period. From 6 PM to 6 AM, 276 (48%) admissions occurred encompassing 88% of trauma patients and 79% of floor transfers. The time distribution was constant for each month and the incidence of postoperative, direct admission, and floor transfer was also constant from month to month, while the incidence of trauma admissions was higher in July and August.

Conclusion

Fifty percent of admissions to the DUMC SICU occur during off-hours when traditionally there has been no attending level in-house supervision. The high percentage of trauma and floor transfers during off-hours validates this reorganization of ICU staffing and around-the-clock supervision.

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