Sequential organ scoring as a measure of effectiveness of care in the high-dependency unit

High-dependency units are of benefit to patients and to the associated inte nsive care unit. However, the effectiveness of high-dependency care has not been quantified. We studied 100 consecutive patients whose high-dependency unit admission was longer than 48 h. The Logistic Organ Dysfunction System was used to assess organ dysfunction on a daily basis in these patients. T he median Logistic Organ Dysfunction System score on admission was 3. The m ean duration of stay was 4.3 days, and the median Logistic Organ Dysfunctio n System score on day 4 was 1. Sixty-six per cent of patients had a lower L ogistic Organ Dysfunction System score at discharge. In the remaining patie nts, the commonest reason for no change or a higher Logistic Organ Dysfunct ion System score was renal dysfunction. High-dependency care is effective i n the majority of patients in terms of improved physiological status and mo st patients were discharged with minor physiological dysfunction. This leve l of physiological dysfunction could be applied as a discharge threshold. P oorer patient outcome is associated with increased age and a longer stay on the unit. This poor outcome was commonly due to renal system dysfunction, and invariably followed surgery.