Time to first review of new admissions to critical care by the consultant intensivist

Introduction

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommends that all new admissions to the ICU should be reviewed by a consultant intensivist within 12 hours [1]. This early review may reduce the ICU length of stay (LOS), but does not appear to affect mortality [2]. Patient severity of illness (APACHE II scores) may also influence patient outcome.

Methods

The database of our clinical information system (MetaVision, iMDsoft) was interrogated and 116 new consecutive critical care admissions were retrospectively reviewed. We ascertained the time to first review (in hours) by a consultant intensivist from MetaVision entry logs. Patient outcomes including mortality and LOS were also captured for patients reviewed early (<12 hours) and late (>12 hours). The admission APACHE II score was also calculated. Continuous and ordered categorical variables are expressed as the median and analysed by the Mann-Whitney U test. Outcome binary variables were analysed by the chi-squared test. P < 0.05 was considered statistically significant.

Results

The early reviewed group (n = 53) had a median first review time of 4.35 hours (IQR 1.70 to 6.90), median LOS of 46 hours (IQR 22 to 86) and mortality of 17% (n = 9). The late review group (n = 63) had a median first review time of 16.55 hours (IQR 14.35 to 18.88), median LOS of 25 hours (IQR 20 to 46) and mortality of 1.6% (n = 1). The median admission APACHE II score for the early group and late group was 14 (IQR 10 to 24) and 10 (IQR 8 to 16), respectively. There was no significant difference in LOS between the two groups (P = 0.137, two-sample Mann-Whitney U test). The early group had a significantly higher mortality (P = 0.03, chi-squared test) and admission APACHE II score (P = 0.04, two-sample Mann-Whitney U test).

Conclusions

We were unable to demonstrate that early consultant intensivist review of new critical care admissions reduces the LOS or mortality. Despite early consultant intensivist review, this group had a significantly higher mortality. A significantly higher severity of illness in the early group may account for this higher mortality.