[Establishment of routines for elective laparoscopic surgery]. / Etablering av rutiner for elektiv laparoskopisk kirurgi.

BACKGROUND: During the autumn of 1999, elective laparoscopic cholecystectomy was introduced as a new surgical procedure in the Central Hospital Østfold, Askim. A prospective evaluation of perioperative patient logistics and patient satisfaction was performed. MATERIAL AND METHODS: 214 patients were evaluated in the ambulatory; 116 of them were scheduled for operation. The operations were performed in general anaesthesia with continuous infusion of propofol and short acting opioides. Analgetics and anti-emetics were given pre- and perioperatively as prophylaxis against postoperative pain and nausea. RESULTS: There were three unexpected cancellations. Two patients had serious postoperative bleedings and two had symptoms indicating residual bile duct stones. Twenty-eight patients (24%) were discharged on the same day. 114 patients (98%) were satisfied with their stay in hospital. INTERPRETATION: The established patient logistics proved efficient and rational.

[Registration of activities at Norwegian anesthesia departments]. / Virksomhetsregistrering ved norske anestesiavdelinger.

Documentation and quality control of anaesthesiologic activity based on electronic data processing is less than optimal in Norwegian departments of anaesthesia. Major efforts have been made to register and store information in large data bases. It has been difficult, however, to put the collected data to practical use. The Norwegian Association of Anaesthesiologists has developed and distributed a data program, NAFREG, which is designed to take care of a minimum set of basic data to serve our needs. In order to obtain data of relevance to quality, a special code list has been developed to facilitate registration of problems related to anaesthesiologic activity. NAFREG has been in use for more than three years, and has been distributed to more than 30 hospitals in Norway. The article evaluates the registration system as practised in six hospitals participating in an evaluation project.

Intensive care: cost and benefit.

This study presents a review of 961 patients treated in the general intensive care unit (ICU) of Akershus Central Hospital (ACH) from 1978 to 1981, including also a follow-up study of the 419 patients treated in 1978 and 1979 who were observed for an average period of 20 months after admittance to the ICU. The ICU patients represented 1.7% of all the patients admitted to the referring departments. Approximately 2/3 (67.3%) of the patients were surgical patients, representing 2.9% of the patients treated in that department, 19.6% were medical patients, and 8.6% came from the department of pediatrics. Surgery was the main reason for ICU admittance in 48.1% of the patients; in 70% of these, surgery by itself made postoperative intensive care necessary. Acute or chronic cardiovascular or respiratory disorders caused or contributed to ICU admittance in 78% of the patients; disorders of the nervous system (29.0%), gastrointestinal system (25%), and severe infections (28%) came next. The average stay in the ICU was 6.2 days. The patient's need for observation, nursing and therapy was assessed daily according to a care grade scale from 1 to 5, with 5 as maximum effort. The average care grade during the stay, multiplied by the duration of stay in days, gave the care product, which was used as an expression of the patient's need for ICU resources. The sum of care products for all the patients through 1 year thus expressed the total work load on the ICU. The ICU budget for 1 year, divided by the total care product for the same year, and thereafter multiplied by the care product for single patients or patient groups, was used as the basis for calculation of ICU costs. Patients receiving mechanical ventilation required 95% of the total work load in the ICU, and 66.3% of these efforts were directly associated with the ventilator treatment period as judged by the care product. Complications to treatment were recorded in 7.3% of the patients, and four of these patients dies of such complications. Improvement by intensive care was achieved in 81.4% of the patients, 5.2% were unchanged, and 13.4% died while in the ICU. Mortality was 9.5% below and 19.3% above the age of 60 years. Of the 419 patients who were followed for an average period of 20 months after admittance to the ICU, 56 died in the ICU, 28 died later during the same stay in ACH, and another 47 died after discharge from ACH, whereas 288 (68.7%) were still alive.(ABSTRACT TRUNCATED AT 400 WORDS)