Costa-Pinto Rahul, Yanase Fumitaka, Kennedy Lucy M, Talbot Lachie J, Flanagan Jeremy Pm, Opdam Helen I, Ellard Louise M, Bellomo Rinaldo, Jones Daryl A
Department of Intensive Care, Austin Hospital, Heidelberg, Australia.
Department of Critical Care, University of Melbourne, Parkville, Australia.
Anaesth Intensive Care. 2023 Jan;51(1):29-37. doi: 10.1177/0310057X221105299. Epub 2022 Oct 10.
Postoperative 'enhanced care' models that sit between critical care and ward-based care may allow for more cost-effective and efficient utilisation of resources for high-risk surgical patients. In this retrospective observational study, we describe an overnight intensive recovery model in a tertiary hospital, termed 'recovery high dependency unit', and the characteristics, treatment, disposition at discharge and in-hospital outcomes of patients admitted to this unit. We included all adult patients (≥18 years) admitted to the recovery high dependency unit for at least one hour between July 2017 and June 2020. Over this three-year period, 1257 patients were included in the study. The median length of stay in the recovery high dependency unit was 12.6 (interquartile range 9.1-15.9) hours and the median length of hospital stay was 8.3 (interquartile range 5.0-17.3) days. Hospital discharge data showed that 1027 (81.7%) patients were discharged home and that 37 (2.9%) patients died. Non-invasive ventilation was delivered to 59 (4.7%) patients and 290 (23.1%) required vasopressor support. A total of 164 patients (13.0%) were admitted to the intensive care unit following their recovery high dependency unit admission. Of the 1093 patients who were discharged to the ward, 70 patients (6.4%) had a medical emergency team call within 24 hours of discharge from the recovery high dependency unit. In this study of a recovery high dependency unit patient cohort, there was a relatively low need for intensive care unit admission postoperatively and a very low incidence of medical emergency team calls post-discharge to the ward. Other institutions may consider the introduction and evaluation of this model in the care of their higher risk surgical patients.
介于重症监护和病房护理之间的术后“强化护理”模式，可能会使高危手术患者的资源利用更具成本效益和效率。在这项回顾性观察研究中，我们描述了一家三级医院的过夜强化康复模式，即“康复高依赖单元”，以及入住该单元的患者的特征、治疗、出院处置情况和院内结局。我们纳入了2017年7月至2020年6月期间入住康复高依赖单元至少1小时的所有成年患者（≥18岁）。在这三年期间，1257名患者被纳入研究。康复高依赖单元的中位住院时间为12.6（四分位间距9.1 - 15.9）小时，住院中位时间为8.3（四分位间距5.0 - 17.3）天。医院出院数据显示，1027名（81.7%）患者出院回家，37名（2.9%）患者死亡。59名（4.7%）患者接受了无创通气，290名（23.1%）患者需要血管活性药物支持。共有164名患者（13.0%）在康复高依赖单元入住后被转入重症监护病房。在1093名出院至病房的患者中，70名（6.4%）在从康复高依赖单元出院后24小时内呼叫了医疗急救团队。在这项对康复高依赖单元患者队列的研究中，术后入住重症监护病房的需求相对较低，出院至病房后医疗急救团队呼叫的发生率非常低。其他机构可考虑引入并评估该模式用于其高危手术患者的护理。
