Analysis of intensive care populations to select possible candidates for high dependency care

Objectives-To identify the proportion, and range across intensive care unit s, of intensive care patients who might potentially be managed on a high de pendency unit (HDU) using three different classification systems. Methods-8095 adult patients admitted to 15 intensive care units in the sout h of England between 1 April 1993 and 31 December 1994 were studied. Patien ts were identified as potential HDU admissions if their APACHE III derived risk of hospital mortality was less than or equal to 10%, if they were cate gorised as a low risk monitor (LRM) patient using the Wagner risk stratific ation method, or if they did not require advanced respiratory support (ARS) . Results-4146 patients (51.2%) had an APACHE III derived risk of hospital de ath of less than or equal to 10%, 1687 (20.8%) were classified as LRM, and 3860 (47.7%) did not receive ARS. The values for each intensive care unit r anged from 32.8-63.3% (APACHE III group), 7.2-29.9% (LRM group), and 14.4-6 8.2% (ARS group). No matter which of the three methods was used, there were significant differences between the 15 units (p<0.0001) with regard to the number of potential HDU patients identified within the scored population. Conclusions-The percentage of intensive care patients who might be more app ropriately managed in a HDU varies considerably between hospitals, and depe nds upon both local circumstances and the method used to define a high depe ndency patient. However, whichever method is used, it appears that signific ant numbers of patients of low dependency status currently fill intensive c are beds in the units studied. If these analyses are correct, the perceived national shortage in intensive care beds might be improved by the developm ent of HDUs.