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EDITORIALS:
Christopher Garrard and Duncan Young
Suboptimal care of patients before admission to intensive care
BMJ 1998; 316: 1841-1842 [Full text]
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[Read Rapid Response] The impact of HDU on ICU work
D W Ryan   (21 September 1998)

The impact of HDU on ICU work 21 September 1998
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D W Ryan

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Re: The impact of HDU on ICU work

Discussion in these columns has debated the value of introducing high dependency units (HDU) as a method of improving the overall provision of care to the ill patient 1,2 and overcoming some of the shortcomings due to lack of intensive care (ICU) beds. I can now report the impact on the ICU workload of the first 40 weeks of opening a 2 bedded (expanded to 4 beds) surgical HDU. Table

The new Unit had 255 planned admissions (233 surgical/32 medical) and 209 unplanned (130/79) in this initial phase, whilst the ICU work continued unabated. At the same time the number of elective major surgical cancellations has fallen to 10 in the time period. These two points confirm Peacock and Edbrooke's earlier observations that the ICU continues to function at its old level but major surgery can usually continue to function irrespective of the ICU workload 3. The readmission rate is unchanged but the ICU discharges 35% of its cases directly into HDU facilities. It is notable how a significant number of medical problems required treatment in both surgical and medical referrals and a large number of these patients would have had to fend as best they could on the ward previously. These findings support Bion's previous argument4 for more HDU resources.

Yours sincerely, Dr D W Ryan Clinical Director, GITU Freeman Hospital, Newcastle upon Tyne NE7 7DN 

  Table

                       HDU                             ICU             
Admissions             464                             420

Mortality               5%                             20%

LOS days             1.6 (1-12)                    3.7(1-34)

Readmission rate       7%                              10%

References:

1. Garrard C, Young D. Suboptimal care of patients before admission to intensive care. BMJ 1998;316:1841-2.

2. Ryan DW. Providing intensive care. BMJ 1996;312:654.

3. Peacock JE, Edbrooke DL. Rationing intensive care. Date from one high-dependency unit supports their effectiveness. BMJ 1995;310:1413.

4. Bion J. Rationing intensive care. BMJ 1995;310:682-3.