RE: “Reduction in mortality after inappropriate early discharge from
intensive care units: Logistic Regression Triage Model”. Daly K et al.
BMJ 2001. 7297: 1274-1276
The Role of High Dependency Unit Care
The increased risk of death reported by Daly et al (1) in patients
discharged prematurely from intensive care units (ICU’s) must surely come
as no surprise. The transfer of those who have been critically ill from
an area where continuous observations of vital signs are routine, to an
area where only peripheral observations are made from time to time (and
less frequently at night) is asking for trouble. Neither does it take any
leap of imagination to appreciate how this can happen when a seriously
expensive facility is under remorseless pressure to improve its
throughput.
What is surprising is that no mention is made of the role of High
Dependency Units (HDU’s) in this scenario. Such units, preferably in the
vicinity of ICU’s are specifically equipped and staffed to provide the
intermediate level of care that such patients often require after
discharge from ICU’s. When necessary, the need for re-admission to
intensive care can then be more swiftly identified. Moreover, when
compared to ICU’s, HDU’s are also intermediate in the consumption of
valuable resources, thereby rationalising the use of the more expensive
facilities.
Daly et al have calculated that an increase of 16% in the UK
provision of intensive care beds is needed in order to reduce the excess
mortality that they have identified. However, it is unclear whether their
calculations include the increased provision of HDU beds. If not, they
should re-calculate, since the reduced resource implications are
considerable.
It is incidentally worth noting that the most recent report of the
National Confidential Enquiry into Peri-operative Deaths concludes that
“High dependency unit care should now be at the top of the list of
priorities for any hospital that does not already have one.”(2,3)
D.L.CROSBY
Hon Consultant Surgeon
G.A.D. REES
Hon Consultant Anaesthetist
University Hospital of Wales, CARDIFF
1. Reduction in mortality after inappropriate early discharge from
intensive care unit: Logistic regression triage Model (DALY K, Beale R,
Chang RSW). BMJ 2001.7297.1274-1276
2. Department of Health (2000a). The 2000 report of the National
Confidential Enquiry into Peri operative deaths. The Stationary Office
London.
3. Mython M, Grocott M, and Goldhill D. Hospital Medicine 2001 Vol
62, No 5
Rapid Response:
The role of high dependency unit care
EDITOR
RE: “Reduction in mortality after inappropriate early discharge from
intensive care units: Logistic Regression Triage Model”. Daly K et al.
BMJ 2001. 7297: 1274-1276
The Role of High Dependency Unit Care
The increased risk of death reported by Daly et al (1) in patients
discharged prematurely from intensive care units (ICU’s) must surely come
as no surprise. The transfer of those who have been critically ill from
an area where continuous observations of vital signs are routine, to an
area where only peripheral observations are made from time to time (and
less frequently at night) is asking for trouble. Neither does it take any
leap of imagination to appreciate how this can happen when a seriously
expensive facility is under remorseless pressure to improve its
throughput.
What is surprising is that no mention is made of the role of High
Dependency Units (HDU’s) in this scenario. Such units, preferably in the
vicinity of ICU’s are specifically equipped and staffed to provide the
intermediate level of care that such patients often require after
discharge from ICU’s. When necessary, the need for re-admission to
intensive care can then be more swiftly identified. Moreover, when
compared to ICU’s, HDU’s are also intermediate in the consumption of
valuable resources, thereby rationalising the use of the more expensive
facilities.
Daly et al have calculated that an increase of 16% in the UK
provision of intensive care beds is needed in order to reduce the excess
mortality that they have identified. However, it is unclear whether their
calculations include the increased provision of HDU beds. If not, they
should re-calculate, since the reduced resource implications are
considerable.
It is incidentally worth noting that the most recent report of the
National Confidential Enquiry into Peri-operative Deaths concludes that
“High dependency unit care should now be at the top of the list of
priorities for any hospital that does not already have one.”(2,3)
D.L.CROSBY
Hon Consultant Surgeon
G.A.D. REES
Hon Consultant Anaesthetist
University Hospital of Wales, CARDIFF
1. Reduction in mortality after inappropriate early discharge from
intensive care unit: Logistic regression triage Model (DALY K, Beale R,
Chang RSW). BMJ 2001.7297.1274-1276
2. Department of Health (2000a). The 2000 report of the National
Confidential Enquiry into Peri operative deaths. The Stationary Office
London.
3. Mython M, Grocott M, and Goldhill D. Hospital Medicine 2001 Vol
62, No 5
Competing interests: No competing interests