A prospective cohort study of 6-month mortality in a community hospital experiencing a gradual reduction in critical care services.
OBJECTIVE
To analyse the effect of reduction of critical care services on admissions, resource consumption and outcome.


METHODS
Observation outcome study with analysis of patient data collected prospectively during 1993, 1995 and 1997.


METHODS
High dependency and intensive care unit (HDU/ICU) of a community hospital serving a population of 168,000. The number of beds decreased from 12 (1993), to 10 (1995) and to 8 (1997) with concomitant decrease in staff.


METHODS
Three patient cohorts admitted to the HDU/ICU during 1993, 1995 and 1997.


RESULTS
Admissions were classified into recovery room care or critical care admissions and stratified according to workload (Levels I-IV). Illness severity scores of critical care admissions were recorded according to the APACHE II system. Mortality data were acquired from a national database. The total number of admissions to the unit did not change over the years. Length of stay decreased significantly over the years. Standardised mortality rates based on mortality within 30 days of discharge from the HDU/ICU were 1.17 (95% confidence interval 0.96-1.43) for critical care admissions during 1993, 0.86 (0.70-1.06) for 1995 and 0.98 (0.79-1.22) for 1997. Survival 180 days after discharge from the HDU/ICU did not differ significantly over the years.


CONCLUSIONS
The results suggest that an excess of resources were used in critical care services during 1993 and 1995. Reduction of HDU/ICU beds by 30% from 7.1 to 4.8 beds/100,000 was not associated with increased 6-month mortality of the patients admitted.
Walther
S M
SM
Department of Anaesthesia and Intensive Care, Vrinnevisjukhuset, 601 82 Norrköping, Sweden. sten.walther@lio.se
Jonasson
U
U
D018806:APACHE; D000328:Adult; D002648:Child; D015331:Cohort Studies; D006295:Health Resources / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors