Pattern of utilization of facilities in the intensive care unit by elective surgical patients in a tertiary care institution: Can the services be provided by high dependency units in surgical wards?

Abstract

Introduction Intensive care is indicated for patients requiring intensive monitoring and/or organ support. It is a costly and time limited resource utilized by those with reversible pathologies and reasonable likelihood of survival. Patients awaiting elective surgery with preoperative intensive care unit (ICU) bookings need to compete with emergency and unanticipated admissions leading to cancellation and postponement of elective surgery, a disadvantage to both the patient and the institution. Hence this study is aimed at evaluating the extent of ICU care utilized by elective surgical patients and to analyse the indications vs. utilization of ICU care by them. Methods This was a retrospective cross-sectional study carried out in the surgical ICU of Colombo South Teaching Hospital, enrolling 47 elective surgical patients admitted to the ICU over a period of 3 months. Data was collected using a pre structured data collection form. Results Majority of the patients were middle aged, belonged to the American Society of Anaesthesiologists Physical Status 2 (68.1%) and underwent colorectal (26%), upper gastrointestinal (GI) (15%) or hepatobiliary (13%) surgeries. Main comorbidities amongst the study population were diabetes and hypertension. Mean duration of ICU stay was 2 days. Most patients were monitored non-invasively within the ICU (68%). Organ support was required by only 17% of patients. Most frequent indication for preoperative ICU booking was the surgical/anaesthetic complexity determined by British United Provident Association (BUPA) schedule of procedures (83%). However, ICU resources were mainly utilized for provision of analgesia particularly in the form of epidural infusions (52%). Recommendations We recommend the development of level 2 care/high dependency units to reduce the burden on the ICU and a unit-based policy for ICU resource allocation for surgical patients