Intended for healthcare professionals


Providing intensive care

BMJ 1996; 312 doi: (Published 08 June 1996) Cite this as: BMJ 1996;312:1476

Cases of trauma can be managed in general intensive therapy units

  1. D F Bowden,
  2. D P Burke
  1. Consultant in accident and emergency Senior registrar, West Midlands regional rotation Manor Hospital, Walsall WS2 9PS

    EDITOR,—D W Ryan points out that increasing resources is one solution to the current crisis in the provision of intensive care services.1 The editorial fails, however, to address the problem of the inefficient use and staffing of some units.

    About 210 cases of major trauma occur in adults each year in Birmingham. About one third of the patients are admitted to the major injuries unit at University Hospital (formerly sited at the Birmingham Accident Hospital). Most of the rest are managed at the two other main district general hospitals. There are 24 general beds in intensive therapy units on the three sites, five of which are allocated to the major injuries unit. The major injuries unit is separately staffed by four consultant anaesthetists and junior anaesthetic staff on rotation and, in addition, has eight consultant and 18 junior orthopaedic staff sharing the on call rota as well as its own complement of nursing staff. The general intensive therapy unit at University Hospital, with six beds, is separately staffed by its own anaesthetists and nursing staff. The two other district general hospitals manage their major trauma workload within existing resources and have no intensive therapy unit beds designated for cases of trauma.

    A recent report on the major injuries unit found no significant difference in outcome between patients admitted from the accident and emergency unit and those admitted direct to the major injuries unit.2 There seems to be no rationale for allocating a fifth of the total complement of intensive therapy unit beds at the three sites to a dedicated trauma intensive therapy unit, particularly when no improvement in outcome can be shown.

    While intensive therapy unit services in Birmingham are undoubtedly underresourced, the resources that are currently available are clearly not being used to their maximum efficiency. The amalgamation of the major injuries unit with the existing on site intensive therapy unit would eliminate duplication of staff and services and lead to savings, which could be used to increase the overall number of beds.


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