Evaluation of the critical care multidisciplinary units workload in relation to the patients severity of illness

ABSTRACT

the objective of this study was to evaluate the worklood in the multidisciplinary critical care units of Alexandria Main University Hospital and its relation to the severity of illness among patient admitted to these units. the study was conducted at the intensive case units [ICU I and III] of critical care department at Alexandria Main University Hospital. Sociodemographic data, diagnosis and outcome were recorded from 694 patients admitted during the three months period from 1st may to end of July 2000. The therapeutic intervention scoring system [TISS] was used to objectively quantify the intensive care services provided in the ICUs and calculate workload indices. Also acute physiology and chronic health evaluation score II [APACHE II] was used to assess severity of illness and obtain the risk of death prediction using the American APACHE II equation. TISS was the highest in haematological [38.1 +/- 7.3], neurological [36.2 +/- 8.45] and septic [35.3 +/- 7.65] patients. While APACHE II score was the highest in ostoperative [36.4 +/- 7.2], toxic [31.7 +/- 8.5] and cardiovascular [26.5 +/- 3.65] patients. A positive coefficient correlation between the two scores were found in haematological and toxic groups of patients [r= 0.52, 0.3 respectively], while no positive coefficient correlation in other systems like cardiovacular, gastrointestinal and metabolic [r= 0.21, 0.1 and 0.23 respectively]. Workload indices of night shifts in units I and III were significantly higher than morning and afternoon shifts [range 0.34-1.23, 0.23-1.32 respectively]. The risk of death prediction using American APACHE II equation compared with the actual mortality incidence were higher in cardiovascular, neurological, traumatic and postoperative patients [t= 3.26*, 1.67, 3.31*, 0.98] while it lower than observed mortality in gastrointestinal, haematological and renal patients [t= 2.8*, 2.01* and 2.02 respectively]. severity of illness scoring is a complex issue reaching many aspects of intensive care practice. It is clear that the commonly used servirty scoring systems are robust tools for measuring the impact of critical illness. They have been extensively validated and revised and they function well in the sphere for which they were designed. Although generalizing our results to all ICUs would be hazardous, we believe that our study, population represents a reliable reflection of our specific conditions