Retrospective audit of ED attendances in intensive care patients to prognostic outcome

ABSTRACT

Introduction: The aim of the audit was to assess the frequency of Emergency Department (ED) attendances before and after Intensive care and correlate this with functional decline and worsening comorbidities. Though the Covid 19 pandemic has highlighted this more starkly1 the implications of prolonged ICU care and increased long term care needs is well established.2 Objectives: A well-structured, comprehensive, multidisciplinary rehabilitation program during and after discharge from the hospital could improve outcomes and prevent further hospital/ED visits. Method: Data was collected using the ITU admission data base for all > 72 hour ITU patient stays over a two year period of 2017-2018 and 2018-2019 in a district general hospital in the UK. Each individual patient's number of same hospital ED attendances for twelve months before and after their ITU admission were reviewed and the causes for them assessed, in addition survival data over a two year period was also reviewed. Results: During 2017-2018 and 2018-2019 a total of 414 and 425 patients were admitted respectively to ITU for more than 72 hours (median= 133.5 hours). Of the total 839 ITU admissions 700 (83.4%) survived ICU stay. 165 (23.6%) of the 700 patients died in subsequent 2 years of ITU discharge. The two year survival rate was 65%. The most common ITU admissions reason was postoperative monitoring (20%) followed by Type 1 respiratory failure (18%) and Type 2 respiratory failure (15%). The median ED attendance was 0 (Range 0 to 29, mean 0.985, S.D 3.985) in the 17-18 and 0 (Range 0 to 24, mean 1.153, SD 2.154) in the 18-19 cohort in the 12 months prior to ITU admission while the median ED attendance was 0 (Range 0 to 15, mean 0.980, S.D 4.4) in the 17-18 and 0 (Range 0 to 15, mean 1.19, SD 2.0) in the 18-19 cohort in the 12 months following the ITU admission. 98% for 17-18 and 72% for 18-19 of ED reattendances following prolonged ITU stay were due to reasons similar to ITU care. Of the 445 patients with no prior ED attendance in 1 year, 168 or 38% (range 1 to 14) had at least one ED attendance in the 12 months following ITU discharge. The remaining 394 patients with at least one ED attendance prior to ICU, 185 or 47% (1 to 15 Range) had ED attendance 12 months following their ITU discharge. Conclusion: The results show that ITU admitted patients consume significant health resources before and after their ITU stay. Patients with no prior ED attendances before ITU admission also reattended in substantial numbers. Most of these attendances were related to their initial reason for ITU admission. A comprehensive rehabilitation program both in hospital and following discharge could improve patients' outcomes, reduce stress on emergency services and improve patient experience. A rehab service was implemented. The need for rehab program for Covid 19 patients during the pandemic has grown immense because of evolving evidence of Long Covid.3.