Intensive care in a general hospital: demographics, utilization and outcomes

INTRODUCTION

Intensive care units (ICU) in Irish academic centres are known to fare as well as their international counterparts. Our aim in this study was to characterise the role and outcomes of an ICU in a smaller Irish hospital and to compare these to international best practice.

METHODS

We reviewed admissions of patients to the ICU of St. Luke's Hospital, Kilkenny. Patient demographics, indications for admission, and outcomes were all recorded and analysed. Sequential organ failure assessment (SOFA) scores were calculated.

RESULTS

Forty-three patients were included in our study, 33 (76.7 %) of which were emergency admissions. Median length of stay was 2 days. The observed mortality rate in our cohort was 20.9 %. The median SOFA score in patients admitted was 7. Higher median SOFA scores on admission were predictive of mortality. The ICU occupancy rate during the duration of our study was 98 %, with only 15 (35.7 %) of admissions to ICU occurring within core working hours.

CONCLUSION

Critical care can be provided safely and in line with current best practice in smaller Irish hospitals. There is a cohort of patients for whom care may be best provided in a tertiary centre, how best to provide for these patients will likely be achieved by early identification (e.g. with SOFA score). Bed capacity issues remain problematic.

Cortisol deficient state. A cause of reversible cognitive impairment and delirium in the elderly

An elderly female who had suffered a stroke was admitted to the Jewish Institute for Geriatric Care (JIGC) for rehabilitation. Three years previously she was found to have a pituitary macroadenoma (prolactinoma) that was treated with radiation therapy. She had been on thyroid replacement for secondary hypothyroidism. Upon admission she was found to have severe cognitive impairment in association with a low plasma cortisol level. After treatment with prednisone there was a dramatic improvement in cognitive function and the patient was able to participate in a rehabilitation program.

Prevention of falls in the elderly population

In response to the challenge posed by falls in the elderly, the Jewish Institute for Geriatric Care established a Falls Clinic. The coordinated expertise of a geriatrician, neurologist, cardiologist, and physiatrist were combined with resources in audiology, ophthalmology, and podiatry. Thirty-six patients enrolled in the study had sustained a total of 36 falls, which resulted in 13 fractures and seven soft-tissue injuries. Falls were a daily occurrence for three patients, weekly for five patients, monthly for ten, semiannually for 14, and yearly for four patients. After a one-year follow-up, 77% of the patients experienced no further falls. We suggest that falls are a multidisciplinary issue and recommend a team approach for successful management.