title: Evolving role of intensive and high-dependency care.
abstract: As stratified patient care evolves, and with an increasing population of elderly patients undergoing major surgery there is a growing demand for critical and high-dependency care beds. Results of an audit comparing the activity of a combined Intensive Care and High-Dependency Unit (ITU/HDU) in 1981 with 1991 has shown an increase in the number of patients admitted, particularly for high-dependency care. The overall mortality in 1981 was 12% compared with 9.5% in 1991. The greatest improvement was seen in ventilated patients, where the mortality was reduced from 54% in 1981 to 30% in 1991. An attempt is made to predict the demand for critical care and high-dependency beds for the future in a population of approximately 250,000 based on current trends. It is perceived that it will be necessary to establish a six-bed ITU and eight high-dependency surgical beds in two separate but adjacent units, where there will be a free interchange of skills at the different levels of care.
authors.affiliation: Department of Surgery, Maelor General Hospital, Wrexham.
authors.forename: D
authors.initials: D
authors.lastname: Nehra
authors.forename: M K
authors.initials: MK
authors.lastname: Crumplin
authors.forename: A
authors.initials: A
authors.lastname: Valijan
authors.forename: A E
authors.initials: AE
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001509:Bed Occupancy / Q000639:trends; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data* / Q000639:trends; D013502:General Surgery / Q000639:trends; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data* / Q000639:trends; D007902:Length of Stay / Q000639:trends; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D014600:Utilization Review; D014852:Wales