Overflow critical care facility in a teaching hospital: how often do we use it?

Introduction

In the United Kingdom there is evidence of inadequate intensive care provision [1], causing delays in critical care admission [2] and interhospital transfer. Recovery rooms are often used as overflow critical care units.

Methods

In 2006 an audit was undertaken of critically ill patients admitted to recovery. Data were collected on the demography, time/source of admission, duration of stay, destination and mortality. The audit was repeated in 2007, following an expansion from 17 to 19 beds in critical care.

Results

Despite the increase in beds, the number of patients admitted to recovery doubled with more medical admissions from wards/A&E during 2006–2007 (40% versus 31%). The reason for use of the facility remains a lack of intensive therapy unit (ITU) beds. The majority were ventilated (>70%) and admitted after-hours. There is significantly higher mortality in emergency patients admitted to the ITU via the overflow facility (Table 1).

Table 1 (abstract P529)

Conclusion

There is increasing use of the overflow facility especially out of hours and for the nonsurgical population. These patients have a higher mortality than those admitted directly to the ITU. We recommend earlier interhospital transfer of critical care patients when an internal bed is not available.