A Registration System in an Intensive Care Unit
A simple registration system is presented that gives information on long term and short term outcome from intensive therapy, on the activity level or life quality after discharge and an evaluation of the function of various organ systems. The system makes comparisons of outcome from therapy in different units possible. The system can be used in a continuous “production” control and can be of help in establishing criterias for selecting patient categories for treatment in the ICU.
During the last thirty years intensive therapy has been developed and intensive care units (ICU) are found in almost all hospitals with acute care.
Though many lives have been saved and the number of units have increased, the ICU’s have remained under almost constant scrutiny and criticism. There have been published several papers (1,2,3) concerning the outcome of intensive therapy, each using their own classification system to measure the success of treatment. It is necessary to compare the outcome for different patient categories treated in different ICU’s, this can only be done if all the units use the same registration system.
In the intensive care unit at Herlev Hospital we have in cooperation with the Danish Institute for Clinical Epidemiology developed a patient registration system that fulfils the needs we have for evaluation of the effects of intensive therapy. The system is designed for data processing and used with specific processing programmes presents the outcome in terms of mortality compared to the expected mortality of a normal population, besides the other informations we gain.
Results of treatment
Demographic data (age, sex, number, origin)
In-unit and in-hospital outcome
The need for ventilatory assistance with a high inspiratory oxygen content.
Parenchymal involvement (kidney, lung, liver)
Immunocompetence (test for anergy)
Patients activity level after discharge.
Mortality after discharge.
Through the National Register we get information concerning the mortality after discharge and the Danish Institute for Clinical Epidemiology can by special processing programmes calculate the expected mortality for a normal population of same age and sex distribution and thereby we get a comparison between our patients’ mortality and the expected mortality, the results are presented in graphic form. Likewise we can compare the long term outcome for patients with a specific diagnosis to a normal population and to the long term outcome for patients with the same diagnosis treated in another ICU.
a continuous production control on our therapy - and in combination with the search for reliable, early identified prognostic indicators.
it contributes to the continued effort of establishing improved criterias for which patients should be selected for intensive therapy with all its ensuing consequences.
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