Jaganath U V, de Vasconcellos K, Skinner D L, Gopalan P D
Discipline of Anaesthesiology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa.
King Edward VIII Hospital and Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa.
South Afr J Crit Care. 2023 Jul 28;39(2). doi: 10.7196/SAJCC.2023.v39i2.867. eCollection 2023.
With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation.
To assess the nature, appropriateness and outcome of referrals to a tertiary centre ICU.
A retrospective review of ICU consults from September 2016 to February 2017 at King Edward VIII Hospital was performed. The study was approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE291/17). Data pertaining to patients' demographics, referring doctor, diagnosis, comorbidities as well as biochemical and haemodynamic parameters were extracted. This information was then cross-referenced to the outcome of the ICU consultation. Data were descriptively analysed.
Five hundred consultations were reviewed over a 6-month period; 52.2% of patients were male and the mean age was 44 years. Junior medical officers referred 164 (32.8%) of the consultations. Although specialist supervision was available in 459 cases, it was only utilised in 339 (73.9%) of these cases. Most referrals were from tertiary (46.8%) or regional (30.4%) hospitals; however, direct referrals from district hospitals and clinics accounted for 20.4% and 1.4% of consultations, respectively. The appropriate referral pathway was not followed in 81 (16.2%) consultations. Forty-five percent of consults were accepted; however, 9.3% of these patients died before arrival in ICU. A total of 151 (30.2%) patients were refused ICU admission, with the majority (57%) of these owing to futility. Patients were unstable at the time of consult in 53.2% of referrals and 34.4% of consults had missing data.
Critically ill patients are often referred by junior doctors without senior consultation, and directly from low-level healthcare facilities. A large proportion of ICU referrals are deemed futile and, of the patients accepted for admission, almost 1 in 10 dies prior to ICU admission. More emphasis needs to be placed on the training of doctors to appropriately triage and manage critically ill patients and ensure appropriate ICU referral and optimising of patient outcomes.
There is a paucity of information related to ICU referrals in South Africa. The nature, appropriateness and outcomes of referrals to a tertiary ICU is discussed in this study.
在资源有限的环境中，重症监护病房（ICU）床位短缺且医疗成本不断上升，临床医生需要对转入ICU的患者进行合理分诊，以避免浪费性支出和不必要的床位使用。
评估转诊至三级中心ICU的性质、合理性及结果。
对2016年9月至2017年2月在爱德华八世国王医院进行的ICU会诊进行回顾性研究。该研究经夸祖鲁-纳塔尔大学医学研究伦理委员会批准（BE291/17）。提取了患者的人口统计学数据、转诊医生、诊断、合并症以及生化和血流动力学参数等相关数据。然后将这些信息与ICU会诊结果进行交叉对照。对数据进行描述性分析。
在6个月的时间里共审查了500例会诊；52.2%的患者为男性，平均年龄为44岁。初级医务人员转诊了164例（32.8%）会诊。虽然459例病例有专科医生监督，但其中只有339例（73.9%）实际得到了利用。大多数转诊来自三级医院（46.8%）或地区医院（30.4%）；然而，直接来自区级医院和诊所的转诊分别占会诊的20.4%和1.4%。81例（16.2%）会诊未遵循适当的转诊途径。45%的会诊被接受；然而，其中9.3%的患者在抵达ICU之前死亡。共有151例（30.2%）患者被拒绝入住ICU，其中大多数（57%）是因为无意义。53.2%的转诊患者在会诊时情况不稳定，34.4%的会诊存在数据缺失。
重症患者常由初级医生在未进行上级会诊的情况下转诊，且直接来自低级别的医疗机构。很大一部分ICU转诊被认为是无意义的，在被接受入院的患者中，几乎每10人中有1人在入住ICU之前死亡。需要更加重视医生培训，以合理分诊和管理重症患者，并确保适当的ICU转诊和优化患者结局。
南非缺乏与ICU转诊相关的信息。本研究讨论了转诊至三级ICU的性质、合理性及结果。
