Cohen A, Bodenham A, Webster N
Intensive Care Unit, St James's Hospital, Leeds.
Anaesthesia. 1993 Feb;48(2):106-10. doi: 10.1111/j.1365-2044.1993.tb06845.x.
The working practices and outcomes from UK intensive care units are poorly documented to date. We have reviewed 2000 consecutive admissions to one intensive care unit in a tertiary referral centre with initially six, then eight beds. The study was a retrospective review of contemporaneous data collection within the period 1986-1990. Demographic details, referral source, admission time, admission diagnosis, APACHE II score, therapeutic interventions, and outcome were recorded. A high overall mortality in the intensive care unit (23%), proportional to APACHE II scoring on admission, was demonstrated. This reflects the referral of many patients who have, or who develop, multiple organ failure. Mortality was significantly higher in patients over the age of 40 years. A total of 69.5% of patients were admitted outside the hours 0800-1800 h on Monday to Friday and admissions peaked between 1200 and 2100 h, demonstrating the need for senior out-of-hours cover. These figures may be used to compare future mortality and work practices in this and other units. The report illustrates some of the advantages and disadvantages of one method of data collection. As it represents one unit only, care must be taken in extrapolating results to others. The timing of admissions suggests that a review of medical staffing practices would be useful.
迄今为止，英国重症监护病房的工作实践和成果记录不完善。我们回顾了一家三级转诊中心的一个重症监护病房连续收治的2000例患者，该病房最初有6张床位，后增至8张。本研究是对1986年至1990年期间同期数据收集情况的回顾性分析。记录了人口统计学细节、转诊来源、入院时间、入院诊断、急性生理学及慢性健康状况评分系统（APACHE II）得分、治疗干预措施及治疗结果。结果显示，该重症监护病房总体死亡率较高（23%），与入院时的APACHE II评分成正比。这反映出许多患者入院时即已存在或在治疗过程中出现多器官功能衰竭。40岁以上患者的死亡率显著更高。共有69.5%的患者在周一至周五的08:00至18:00以外的时间入院，入院高峰出现在12:00至21:00之间，这表明需要安排高级别的非工作时间医护人员值班。这些数据可用于比较该病房及其他病房未来的死亡率和工作实践情况。本报告阐述了一种数据收集方法的一些优缺点。由于它仅代表一个病房的情况，在将结果推广至其他病房时必须谨慎。入院时间的情况表明，对医护人员配备做法进行审查会很有帮助。
