Abstract
Giriş
Acil serviste değerlendirilen kritik hastaların, üçüncü basamak yoğun bakım ünitesine yatış kriterlerini tanımlayarak, alt basamak yoğun bakım ve palyatif bakım kapasite yetersizliğinin son basamak yoğun bakımlara olan etkisini anlatmayı amaçladık.
Gereç ve Yöntemler
Hastanemizde 2016-2019 tarihleri arasında erişkin acil servisten anestezi yoğun bakım ünitesine yatışı yapılan 18 yaş üstü kritik hastalar çalışmaya dahil edilmiştir. Hastaların arşiv dosyalarından ve hastane bilgi sisteminden edinilen demografik özellikleri, yoğun bakım yatışı boyunca verilen destek tedaviler, yoğun bakım ve hastane mortaliteleri kaydedilmiş, yoğun bakım yatış öncelik modelleri ile palyatif bakım endikasyonları belirlenerek uygunsuz yatışlar tespit edilmiştir.
Bulgular
Çalışmaya alınan 300 hastanın 182’si (%60.7) erkek, 118 (%39.3) kadındır. Hastalarda en sık komorbidler sırasıyla KOAH [87/300, (%29)], Alzheimer-Demans [(54/300, (%18)], Koroner Arter Hastalığı [(46/300, (%15.3)] olduğu bulundu. 197(%65) hasta IMV, 66 hasta (%22) NIV, 10 hasta (%3.5) HFNO desteği almaktadır. Hastalar bakanlık yatış modeline göre 110 (%36), öncelik yatış modeline göre 79 (%26), palyatif yatış modeline göre 37 (%12) uygunsuz yatış olduğu bulunmuştur. Bakanlık modeli ve öncelik modelinin ortak olarak tespit ettiği uygunsuz yatış sayısı ise 60 (%20) olduğu saptanmıştır. Her iki modelin ortak tespit ettiği 60 hastada palyatif bakım yatış açısından değerlendirildiğinde, palyatif bakım endikasyonu olan hasta sayısı 18 saptanmıştır. Tüm hastalarda YBÜ mortalitesi %30 hastane mortalitesi %38.7 bulunmuştur. Bu oranlar sağlık bakanlığı kriterlerinin uygunsuz yatış olarak değerlendirdiği grupta YBÜ mortalitesi %24, hastane mortalitesi %30, öncelik modeli kriterlerinin uygunsuz yatış kabul ettiği grupta ise YBÜ mortalitesi %30, hastane mortalitesi %35 bulunmuştur. İki grubun ortak tespit ettiği uygunsuz yatışlarda ise YBÜ mortalitesi %30 hastane mortalitesi %31 tespit edilmiştir. Palyatif bakım endikasyonu olan grupta ise YBÜ mortalitesi %43, hastane mortalitesi %51 bulunmuştur.
Sonuç
Kritik hasta popülasyonun artması ve yatak sayısının sınırlı olması nedeniyle hastane yönetimleri kritik bakım ve palyatif bakım ünitelerinin kapasitelerini artırmaya yönelik önlemleri almalıdır. Ayrıca evde ve sağlık merkezlerinde palyatif bakım ve hospis desteği verebilecek kuruluşların oluşturulması, acil servis başvurularının azalmasına yardımcı olabilir.
References
- 1. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J. Current and projected workforce requirements for care of the critically III and patients with pulmonary disease: Can we meet the requirements of an aging population? J Am Med Assoc. 2000;
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- 5. Barnard D, Weissman DE, Meier DE, Spragens LH. Policies and tools for hospital palliative care programs: A crosswalk of National Quality Forum preferred practices. J Palliat Med. 2004;
- 6. Balci C, Sungurtekin H, Gürses E, Sungurtekin U. Septik ve nonseptik hastalarda APACHE II, APACHE III, SOFA skorlama sistemleri, trombosit düzeyleri ve mortalite. Ulus Travma ve Acil Cerrahi Derg. 2005;
- 7. Chiavone PA, dos Santos Sens YA. Evaluation of APACHE II system among intensive care patients at a teaching hospital. Sao Paulo Med J. 2003;
- 8. Derlet RW. Overcrowding in emergency departments: Increased demand and decreased capacity. Ann Emerg Med. 2002;
- 9. Mahony SO, Blank A, Simpson J, Persaud J, Huvane B, McAllen S, et al. Preliminary report of a palliative care and case management project in an emergency department for chronically ill elderly patients. J Urban Heal. 2008;
- 10. Beynon T, Gomes B, Murtagh FEM, Glucksman E, Parfitt A, Burman R, et al. How common are palliative care needs among older people who die in the emergency department? Emerg Med J. 2011;
- 11. Grudzen CR, Richardson LD, Morrison M, Cho E, Sean Morrison R. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;
- 12. Caldeira VMH, Silva Júnior JM, Oliveira AMRR de, Rezende S, Araújo LAG de, Santana MR de O, et al. Critérios para admissão de pacientes na unidade de terapia intensiva e mortalidade TT - Criteria for patient admissiwwon in the intensive care unit and mortality rate. Rev Assoc Med Bras. 2010;
- 13. S.Bakanlığı. Sağlık İstatistikleri yıllığı 2011, Sağlık Bakanlığı.
- 14. Kepekci AB, Erdoǧan E, Zivali M. Frequency of Palliative Care Patients in a Second Level Intensive Care Unit: Retrospective Study. Anestezi Derg. 2019;27(3):193–7.
- 15. Sungurtekin H, Yalçın S. Evaluation of the End Stage Patients in Intensive Care. Turkish J Intensive Care. 2022 Dec 29;0(0):0–0.
EVALUATION OF CRITICAL PATIENT ADMISSIONS FROM THE EMERGENCY DEPARTMENT TO THE ANESTHESIA INTENSIVE CARE UNIT
Abstract
Objective
We aimed to describe the effects of level 1-2 intensive care and palliative care capacity inadequacy on tertiary intensive care units by defining the criteria for hospitalization in the tertiary intensive care unit of critically ill patients evaluated in the emergency department.
Materials and Methods
Critical patients over the age of 18 who were admitted to the anesthesia intensive care unit from the adult emergency department at Dokuz Eylül University Hospital between 2016-2019 were included in the study. Demographic characteristics of patients obtained from archive files and hospital information system, supportive treatments given during intensive care hospitalization, intensive care and hospital mortality were recorded, and inappropriate hospitalizations were determined by determining intensive care hospitalization priority models and palliative care indications.
Results
Of the 300 patients included in the study, 182 (60.7%) were male and 118 (39.3%) were female. The most common comorbidities in patients were found to be COPD [87/300, (29%)], Alzheimer-Dementia [(54/300, (18%)], Coronary Artery Disease [(46/300, (15.3%)], respectively. (65%) patients receive IMV, 66 (22%) NIV, 10 (3.5%) HFNO support. Patients were found to be inappropriately hospitalized according to the ministry hospitalization model, 110 (36%), according to the priority hospitalization model, 79 (26%), and 37 (12%) according to the palliative hospitalization model. The number of inappropriate hospitalizations determined jointly by the ministry model and priority model was found to be 60 (20%). When palliative care was evaluated in terms of hospitalization in 60 patients, which were determined by both models, the number of patients with palliative care indication was 18. In all patients, ICU mortality was 30% and hospital mortality was 38.7%. These rates were found to be 24%, hospital mortality, and 30% in the group in which the criteria of the Ministry of Health evaluated as inappropriate hospitalization, and 30% and 35% in the hospital, in the group in which priority model criteria considered inappropriate hospitalization. ICU mortality was 30% and hospital mortality was 31% in inappropriate hospitalizations jointly determined by the two groups. In the group with palliative care indication, ICU mortality was 43% and hospital mortality was 51%.
Conclusion
Due to the increase in the critically ill population and the limited number of beds, hospital administrations should take measures to increase the capacities of critical care and palliative care units. In addition, the establishment of institutions that can provide palliative care and hospice support at home and health centers can help reduce emergency service applications.
References
- 1. Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J. Current and projected workforce requirements for care of the critically III and patients with pulmonary disease: Can we meet the requirements of an aging population? J Am Med Assoc. 2000;
- 2. Sprung CL, Baras M, Iapichino G, Kesecioglu J, Lippert A, Hargreaves C, et al. The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores. Crit Care Med. 2012;
- 3. Sprung CL, Artigas A, Kesecioglu J, Pezzi A, Wiis J, Pirracchio R, et al. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly. Crit Care Med. 2012;
- 4. Sağlık Bakanlığı. Yataklı Sağlık Tesislerinde Yoğun Bakım Hizmetlerinin Uygulama Usul ve Esasları Hakkında Tebliğ-28208, Sağlık Bakanlığı. 18.2.2012. In.
- 5. Barnard D, Weissman DE, Meier DE, Spragens LH. Policies and tools for hospital palliative care programs: A crosswalk of National Quality Forum preferred practices. J Palliat Med. 2004;
- 6. Balci C, Sungurtekin H, Gürses E, Sungurtekin U. Septik ve nonseptik hastalarda APACHE II, APACHE III, SOFA skorlama sistemleri, trombosit düzeyleri ve mortalite. Ulus Travma ve Acil Cerrahi Derg. 2005;
- 7. Chiavone PA, dos Santos Sens YA. Evaluation of APACHE II system among intensive care patients at a teaching hospital. Sao Paulo Med J. 2003;
- 8. Derlet RW. Overcrowding in emergency departments: Increased demand and decreased capacity. Ann Emerg Med. 2002;
- 9. Mahony SO, Blank A, Simpson J, Persaud J, Huvane B, McAllen S, et al. Preliminary report of a palliative care and case management project in an emergency department for chronically ill elderly patients. J Urban Heal. 2008;
- 10. Beynon T, Gomes B, Murtagh FEM, Glucksman E, Parfitt A, Burman R, et al. How common are palliative care needs among older people who die in the emergency department? Emerg Med J. 2011;
- 11. Grudzen CR, Richardson LD, Morrison M, Cho E, Sean Morrison R. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;
- 12. Caldeira VMH, Silva Júnior JM, Oliveira AMRR de, Rezende S, Araújo LAG de, Santana MR de O, et al. Critérios para admissão de pacientes na unidade de terapia intensiva e mortalidade TT - Criteria for patient admissiwwon in the intensive care unit and mortality rate. Rev Assoc Med Bras. 2010;
- 13. S.Bakanlığı. Sağlık İstatistikleri yıllığı 2011, Sağlık Bakanlığı.
- 14. Kepekci AB, Erdoǧan E, Zivali M. Frequency of Palliative Care Patients in a Second Level Intensive Care Unit: Retrospective Study. Anestezi Derg. 2019;27(3):193–7.
- 15. Sungurtekin H, Yalçın S. Evaluation of the End Stage Patients in Intensive Care. Turkish J Intensive Care. 2022 Dec 29;0(0):0–0.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Intensive Care |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 6, 2023 |
| Submission Date | May 4, 2023 |
| Published in Issue | Year 2023 Volume: 37 Issue: 2 |
