Acil Servise Kritik Hasta Başvurusu Ve Yoğun Bakım Yatışlarının Değerlendirilmesi
Özet
The number of critically ill, elderly patients with multiple comorbidities and oncological problems who present to Emergency department (ED) are increasing and due to the fact that patients who are in need of critical care are growing in number. Between April 15th and September 14th 2013, 400 patients (2.86% of ED visits) were consulted for intensive care unit (ICU) admission from Hacettepe University Emergency Department. Inappropriate consultations for ICU admissions were 8%; priority model, 7.8%; diagnosis model, and 37.9%; objective parameters model. Admissions of critically ill patients were 269 (67.3%) to intensive care unit, 48 (12%) to palliative service, and 22 (5.4%) to acute care services. Also, inappropriate admissions for ICU were 11.9%; priority model, 11.4%; diagnosis model, and 58%; objective parameters model. 61 patients (15.3%) had to be treated in the ED because admissions to other departments were not possible. Patients who were treated in the ED had higher scores compared to the patients who were admitted to intensive care units, for ages (mean 67 (28 – 97) v 60 (18 – 94)), priority model 3 (82% v 11.9%), sepsis (49.2% v 5.9%), diagnosis of pulmonary system diseases (50.8% v 14.5%), diagnosis of gastrointestinal system diseases (13.2% v 3.7%), malignancies (60.7% v 21.2%) and mortalities (75.4% v 20.4%). Mortality of patients, who were admitted to ICUs in 24-72 hours, was 2.4 times higher than the mortality of patients who were admitted in 24 hours. ED physicians should be careful about critically ill patient triage and manage those patients properly for required critical care areas (ICU, acute care, palliative care unit). Hospital managements should develop policies for growing population of critically ill patients who present to EDs. Developing palliative care for homes and health centers, may help reduce ED visits and crowdings.
