Demand for beds in intensive medicine
Admission process to the intensive treatment center of the Hospital de Clínicas for a month
Abstract
Objective: to study bed supply and access to an intensive care unit of the Hospital de Clínicas in June 2005.
Methods: a prospective, observational design to inquire critical patients not located at ICU was displayed during a month. Patients from the anaesthesia recovering, emergency and intermediate units were visited every day in June 2005.
Results: sixty four patients took part of the study, 14 were referred to ICU within 24 hours (group 1), the remaining patients went to ICU after 24 hours or were not referred to ICU (group 2). Age was higher in group 2, no differences were seen in APACHE II. Follow-up of group 2 showed that part of this population was no longer critical patients (recovered or non-recuperable patients), while other part had ICU indication: subgroup B. This subgroup duplicated mortality of group 1 (35,7% vs 70,8%, p = 0,038) and no differences in APACHE II. Part of subgroup B accessed ICU lately (3,5 days): subgroup T. APACHE II of subgroup T at entry of ICU was higher than group 1 (31,5 vs 16, p = 0,012). To sum up, 271 days/no bed supply (median 9 beds/day) were recorded.
Conclusions: a bed deficit in Intensive Medicine was recorded in the Hospital de Clínicas. The group that entered to ICU within 24 hours had younger patients and lower mortality. The group of later access to ICU had documented deterioration.
Bioethics discussion and early access to ICU are main factors to treat patients.
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