A Ten-Year Review of the Management of Medical Patients in the Intensive Care Unit in a Resource-Poor Setting in Southern Nigeria
DOI:
https://doi.org/10.47672/ajhmn.1536Keywords:
Intensive Care Unit ICU, Mortality, Mean Age, Bill, Transferred Out, Discharged.Abstract
Purpose: The Intensive Care Unit (ICU) is a specialist ward within a hospital, with a concentration of expertise and resources for the management of critically ill patients. Some clinicians think of the ICU only in relation to surgical practice, maybe because many intensivists are anaesthesiologists and anaesthesia is closely linked to surgery. However, this notion may not be entirely true. This study aims to highlight the importance of the ICU to patients with medical challenges.
Methodology: This is a ten-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital's ethical committee. All patients who were admitted into the ICU with medical diagnosis were included in this study. The information gotten includes history, age, sex, diagnosis, length of admission, and outcome. The data collected was analyzed and presented in tables and charts.
Findings: The mean age was 51.41±20.12. The highest age was 95 years. The mean bill paid was 80,718.55 Naira and the largest bill paid was 605,500 Naira while the least bill paid was 2000. The mean duration of stay was 6.59 days and ranged from a day to 120 days. The males were 268 (51.8%) while the females were 249(48.2%). Two hundred and sixty-five patients (51.3%) died during the study period. Patients who were transferred out of the ICU spent the highest amount of money and spent the most time (10.19 days) in the ICU. The patient who died spent the least amount of time (4.56 days) in the ICU. A hundred and two patients were discharged from the ICU. Transferring them to a high dependency unit or ward will save cost. As the age increased, the comorbidities also increased with 309 out of 517 having comorbidities. Exacerbation of comorbidity led to admission in the ICU.
Recommendation: Medical patients admitted into the ICU tend to have a higher mean age and have a higher mortality rate. Older patients tend to have more comorbidity. Proper and effective management of the ICU will save cost. Proper management of comorbidities in older patients can lead to an improvement in health. Patients who are fit, could be transferred to other wards and discharged from there, this will free up beds in the ICU, increase effective use of the ICU and save cost.
Downloads
References
Stretch B, Shepherd SJ. Criteria for intensive care unit admission and severity of illness. Surgery (Oxford). 2021 Jan 1;39(1):22-8.
Fujii Y, Hirota K, Muranishi K, Mori Y, Kambara K, Nishikawa Y, Hashiguchi M. Clinical impact of physician staffing transition in intensive care units: a retrospective observational study. BMC anesthesiology. 2022 Dec;22(1):1-0.
Atumanya P, Sendagire C, Wabule A, Mukisa J, Ssemogerere L, Kwizera A, Agaba PK. Assessment of the current capacity of intensive care units in Uganda; A descriptive study. Journal of critical care. 2020 Feb 1; 55:95-9.
Rochefort CM, Beauchamp ME, Audet LA, Abrahamowicz M, Bourgault P. Associations of 4 nurse staffing practices with hospital mortality. Medical care. 2020 Oct;58(10):912.
Suter PM. Good rules for ICU admission allow a fair allocation of resources, even in a pandemic. Swiss medical weekly. 2020 Mar 24;150(1314): w20230-34.
Tambone V, Boudreau D, Ciccozzi M, Sanders K, Campanozzi LL, Wathuta J, Violante L, Cauda R, Petrini C, Abbate A, Alloni R. Ethical criteria for the admission and management of patients in the ICU under conditions of limited medical resources: a shared international proposal in view of the COVID-19 pandemic. Frontiers in public health. 2020 Jun 16; 8:284.
Williams C, Wheeler D. Criteria for ICU admission and severity of illness scoring. Surgery (Oxford). 2009 May 1;27(5):201-6.
Anesi GL, Gabler NB, Allorto NL, Cairns C, Weissman GE, Kohn R, Halpern SD, Wise RD. Intensive care unit capacity strain and outcomes of critical illness in a resource-limited setting: A 2-hospital study in South Africa. Journal of intensive care medicine. 2020 Oct;35(10):1104-11.
Craig J, Kalanxhi E, Hauck S. National estimates of critical care capacity in 54 African countries. MedRxiv. 2020 May 16:2020-05.
Mato CN, Onwuchekwa AC, Aggo AT. The pattern of admissions to the University of Port Harcourt Teaching Hospital intensive care unit-a 10-year analysis. Southern African Journal of Critical Care. 2009;25(1).
Mahbub M, Srinivasan S, Danciu I, Peluso A, Begoli E, Tamang S, Peterson GD. Unstructured clinical notes within the 24 hours since admission predict short, mid & long-term mortality in adult ICU patients. Plos one. 2022 Jan 6;17(1):e0262182.
Rahmatinejad Z, Rahmatinejad F, Sezavar M, Tohidinezhad F, Abu-Hanna A, Eslami S. Internal validation and evaluation of the predictive performance of models based on the PRISM-3 (Pediatric Risk of Mortality) and PIM-3 (Pediatric Index of Mortality) scoring systems for predicting mortality in Pediatric Intensive Care Units (PICUs). BMC pediatrics. 2022 Apr 12;22(1):199.
Beigmohammadi MT, Amoozadeh L, Rezaei Motlagh F, Rahimi M, Maghsoudloo M, Jafarnejad B, Eslami B, Salehi MR, Zendehdel K. Mortality predictive value of APACHE II and SOFA scores in COVID-19 patients in the intensive care unit. Canadian Respiratory Journal. 2022 Oct;2022.
Granholm A, Anthon CT, Kjær MB, Maagaard M, Kaas-Hansen BS, Sivapalan P, Schjørring OL, Andersen LW, Mathiesen O, Strøm T, Jensen AK. Patient-important outcomes other than mortality in contemporary ICU trials: a scoping review. Critical Care Medicine. 2022 Jul 27;50(10):e759-71.
Johnson U, Ibeanusi S, Kejeh B. Audit of admissions and outcome of patients with burns in the intensive care unit of a Tertiary Hospital in Port Harcourt, Nigeria. Journal of Advances in Medical and Pharmaceutical Sciences. 2018 May 19;17(1):1-9.
Jaja BN, Eghwrudjakpor PO. Effect of demographic and injury etiologic factors on intensive care unit mortality after severe head injury in a low middle-income country. Annals of African medicine. 2014 Oct 1;13(4):204.
Green K, Orazulike N. Obstetric Admission into the Intensive Care Unit (ICU) of the University of Port Harcourt Teaching Hospital: A Ten-Year Review. Journal of Advances in Medicine and Medical Research. 2018 Mar 17;25(9):1-7.
Otokwala JG, John OC. A 365-Day Record of Maternal Admissions in Intensive Care Unit at the University of Port Harcourt Teaching Hospital in Nigeria. Journal of Biosciences and Medicines. 2023 Apr 3;11(4):296-303.
El-Sarnagawy GN, Abdelnoor AA, Abuelfadl AA, El-Mehallawi IH. Comparison between various scoring systems in predicting the need for intensive care unit admission of acute pesticide-poisoned patients. Environmental Science and Pollution Research. 2022 May 1:1-1.
Endacott R, Pattison N, Dall'Ora C, Griffiths P, Richardson A, Pearce S, SEISMIC Study Team. The organisation of nurse staffing in intensive care units: a qualitative study. Journal of Nursing Management. 2022 Jul;30(5):1283-94.
Harboun M, Ankri J. Comorbidity indexes: review of the literature and application to studies of elderly population. Revue D'epidemiologie et de Sante Publique. 2001 Jun 1;49(3):287-98.
Argano C, Natoli G, Mularo S, Nobili A, Monaco ML, Mannucci PM, Perticone F, Pietrangelo A, Corrao S. Impact of diabetes mellitus and its comorbidities on elderly patients hospitalized in internal medicine wards: data from the RePoSi registry. InHealthcare 2022 Jan 3 (Vol. 10, No. 1, p. 86). MDPI.
Iheonu C, Urama NE. Addressing poverty challenges in Nigeria. africaportal.org: 22-45.
Vester LB, Holm A, Dreyer P. Patients' and relatives' experiences of post"ICU everyday life: A qualitative study. Nursing in critical care. 2022 May;27(3):392-400.
Huang X, Liu L, Eli B, Wang J, Chen Y, Liu Z. Mental Health of COVID-19 Survivors at 6 and 12 Months Postdiagnosis: A Cohort Study. Frontiers in Psychiatry. 2022 Apr 8; 13:863698.
Rosenthal VD, Yin R, Lu Y, Rodrigues C, Myatra SN, Kharbanda M, Valderrama-Beltran SL, Mehta Y, Daboor MA, Todi SK, Aguirre-Avalos G. The impact of healthcare-associated infections on mortality in ICU: a prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East. American journal of infection control. 2023 Jun 1;51(6):675-82.
Ntuli ST, Mogale M, Hyera FL, Naidoo S. An investigation of maternal mortality at a tertiary hospital of the Limpopo province of South Africa. Southern African journal of infectious diseases. 2017 Aug 1;32(2):73-6.
Demoule A, Jung B, Prodanovic H, Molinari N, Chanques G, Coirault C, Matecki S, Duguet A, Similowski T, Jaber S. Diaphragm dysfunction on admission to the intensive care unit. Prevalence, risk factors, and prognostic impact"”a prospective study. American journal of respiratory and critical care medicine. 2013 Jul 15;188(2):213-9.
Marty P, Roquilly A, Valle F, Luzi A, Ferr F, Fourcade O, Asehnoune K, Minville V. Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study. Annals of intensive care. 2013 Dec;3(1):1-7.
Abhulimen Victor, Oruobu-Nwogu Ayanate. A ten-year review of the management of surgical patients in the Intensive Care Unit. World Journal of Advanced Research and Reviews,2023,19(01),657-666.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Abhulimen Victor, Oruobu-Nwogu Ayanate
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
