Nature of care in Intensive Care Unit at King Chulalongkorn Memorial Hospital

Abstract

Introduction : Only recently that chronic diseases have been found increasing due to longer life spans of human beings. Meanwhile, the development of medical technology has been saving many lives. Nevertheless, it also artificially prolongs the lives terminal patients. In actual situations, there have been widely scarce of ICU cares or negative balance in demand and supply of ICU cares. A cause of the scarcity might be unintentional provision of ICU for caring at the end of life. However, there has been no investigation on the nature of care in ICUs of King Chulalongkorn Memorial Hospital. The authors considered if there have been data regarding the nature of cares in term of resource allocation in intensive care units, it would be useful for future ICU management

Objectives : (1) To explore lengths of stay in ICU of King Chulalongkorn Memorial Hospital; (2) To explore proportions in term of number and time consumption of non-survivors and survivors in ICU of King Chulalongkorn Memorial Hospital.

Research design : A retrospective study. Patients The target of population survey is adult

patients : (age>15 years) who were admitted in ICUs at King Chulalongkorn Memorial Hospital from January to December, 2007.

Methods : Data were collected in term of numbers of the target population based on the formal records from the department of registration and reviewed ICU medical records. Then, number of the target group, i.e., survivors, and non-survivors were counted. The length of stay (LOS) in ICU of the patients, underlying conditions, medical treatment and demographic data of both groups of patients were categorized and recorded in numbers. Descriptive statistics: percentage was used for numerical and categorical variables; mean and standard deviation were used for length of stay in ICU. As for inferential statistics, Chisquare was used for comparison between the survivors and nonsurvivors.

Results : Total target population was 2,828 patients. Three hundred and eleven patients died and the overall mortality rate was 10.99%. As for the overall admissions, the longer average LOS groups were in MED1 ICU (160.27 ± 259.28 hr.). The shortest average LOS was in Obstetrics and Gynecological ICU (40.95 ± 47.46 hr). Overall the proportion of time consumption of the survivors and non-survivors were 3:1. The overall proportion of number of survivors and non- survivors were 9:1. There have been differences of these proportions among different types of ICU. The proportions of number of survivors and non-survivors of MED1 and 2 ICU were 1.74:1 and 0.98:1 respectively.

Discussion : The overall proportion of number of survivors and non-survivors of 9:1 indicated the nature of ICU cares at King Chulalongkorn Hospital were not spent as places for patients at the end of lives. However, there has been an earlier study in the US that 1 in 5 patients did not survived in some intensive cares. These might possibly imply that the intensive care units would become places for patients at the end of lives in the near future. The main findings from this study showed that the medical ICUs tended to be places for caring patients at the end of lives. Other findings such as CPR action or the very short period of admission, might imply lack of end-of-life care application

Conclusion : The research question whether the ICUs are places for caring patients at the end of lives was replied. That was ICUs at King Chulalongkorn Memorial Hospital were normally not allocated for those who at the end of lives. Because the overall proportion of number of survivors and non-survivors was less than of the western report and the overall time consumption of survivors was higher than of non-survivors. However, the medical ICUs tended to be places for caring patients at the end of lives. Some remarkable findings implied some problems of decision makings regarding end-of-life care that might lead ICUs to be places for caring patients at the end of lives. The in-depth study should be further investigated