A PILOT-STUDY OF THE USE OF CLINICAL GUIDELINES TO DETERMINE APPROPRIATENESS OF PATIENT PLACEMENT ON INTENSIVE AND HIGH DEPENDENCY CARE UNITS

Background With growing pressure to contain costs without adversely af fecting standards of care it is particularly important that expensive High Dependency and Intensive Care facilities are developed and used i n a coherent and accountable way. We present a study which examines in detail practice in South Glamorgan Health Authority during a five wee k period in April-May 1993. Methods Agreed criteria for admission to H igh Dependency and Intensive Care were produced by a multidisciplinary group of clinical consultants and senior nurses. These criteria, whic h were subject to peer scrutiny and subsequently endorsed by the relev ant local medical advisory structure, were used as a basis against whi ch to audit current practice. Results Over the period of the study onl y 2 . 4 per cent (3/125) of Intensive Care patients were found to be i nappropriately placed, However, the use of different types of High Dep endency beds was less satisfactory. A Care of the Elderly Unit did not appear to function in a High Dependency role at all, and inappropriat e placement on others ranged from 41 per cent (12/29) for a general un it (where half fulfilled the criteria for Intensive Care) up to 76 per cent (13/17) for a cardiac surgical unit (where the majority could ha ve been placed on wards at the time surveyed). Only 0 . 29 per cent (2 1/7259) of ward patients fulfilled High Dependency criteria and 0 . 03 per cent (2/7259) those for Intensive Care. Conclusion This study con cludes that whereas placement in Intensive Care or on the ward appeare d non-controversial, the decision to place patients in a High Dependen cy Unit was less straightforward. Many patients could more appropriate ly have been placed elsewhere. The authors suggest that High Dependenc y bed use could be rationalized by the introduction of professionally derived guidelines and that the current nationwide push to develop mor e High Dependency facilities should be dependent upon, and tempered by , the development of such clinical consensus.