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Timing of first review of new ICU admissions by consultant intensivists in a UK district general hospital

Introduction

Patient outcome has been linked to the timing of the first senior medical review in emergency medical admissions to hospital, and after ICU admission [1, 2]. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2005 report revealed that in participating UK ICUs 75% of new ICU patients had a consultant intensivist review within 12 hours of admission [3]. This is now a recommended standard, although data were only available for 40% of patients, and neither supportive patient outcome data nor pre-ICU review timings were cited.

Methods

By retrospective review of patients' ICU medical notes, we studied the length of time in hours to first consultant intensivist review before and after ICU admission in 122 consecutive patients. We also examined mortality and length of stay (LOS) outcomes in patients reviewed early (<12 hours) and late (>12 hours) after ICU admission. Continuous data are expressed as the median (IQR).

Results

Overall, data were available for 96 patients reviewed after ICU admission (median = 6.0, IQR = 1.1 to 14.7 hours), 79 (82%) of these reviews being early (median = 3, IQR = 0.5 to 7.5). ICU mortality for the early group was 31.6% during a median ICU LOS of 1.8 days (IQR = 0.9 to 7.9). Median review time for the late group (n = 17) was 21 hours (IQR = 18.5 to 28.4), with an ICU mortality of 23.5%, during a median ICU LOS of 8.1 days (IQR = 2.1 to 14). The early group had a significantly shorter ICU LOS (P = 0.007, two-sided Mann–Whitney test) than the late group, and there was no significant proportional difference in ICU mortality between the two groups. Furthermore, before ICU admission, 56/122 patients (46%) had been reviewed by a consultant intensivist (median = 2.2, IQR = 1.2 to 4.0 hours), and in many patients this constituted the only such review prior to 12 hours into ICU admission.

Conclusion

Review by a consultant intensivist is common before ICU admission. Early review after ICU admission may be associated with a shorter length of ICU stay. Timing of the first review is likely to be influenced by many factors, other than NCEPOD recommendations.

References

  1. 1.

    McQuillan P, et al.: Confidential inquiry into quality of care before admission to intensive care. BMJ 1998, 316: 1853-1858.

  2. 2.

    Seward E, et al.: A confidential study of deaths after emergency medical admission: issues relating to quality of care. Clin Med 2003, 3: 425-434. [http://www.ncepod.org.uk]

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Mullen, P., Dawood, A., White, J. et al. Timing of first review of new ICU admissions by consultant intensivists in a UK district general hospital. Crit Care 13, P476 (2009). https://doi.org/10.1186/cc7640

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Keywords

  • Median Review
  • Early Group
  • District General Hospital
  • Medical Admission
  • Review Time