Identifying Priorities in Intensive Care : a description of a system for collecting intensive care data, an analysis of the data collected, a critique of aspects of severity scoring systems used to compare intensive care outcome, identification of priorities in intensive care and proposals to improve outcome for intensive care patients.
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This thesis reviews the requirements for intensive care audit data and describes the
development of ICARUS (Intensive Care Audit and Resource Utilisation System), a
system to collect and analyse intensive care audit information. By the end of 1998
ICARUS contained information on over 45,000 intensive care admissions. A study
was performed to determine the accuracy of the data collection and entry in ICARUS.
The data in ICARUS was used to investigate some limitations of the APACHE II
severity scoring system. The studies examined the effect of changes in physiological
values and post-intensive care deaths, and the effect of casemix adjustment on
mortality predicted by APACHE II. A hypothesis is presented that excess intensive
care mortality in the United Kingdom may be concealed by intensive care mortality
prediction models. A critical analysis of ICARUS data was undertaken to identify
patient groups most likely to benefit from intensive care.
This analysis revealed a high mortality in critically ill patients admitted from the
wards to the intensive care unit. To help identify critically ill ward patients, the
physiological values and procedures in the 24 hours before intensive care admission
from the ward were recorded: examination of the results suggested that management
of these patients could be improved. This led to the setting up of a patient at risk team
(PART). Two studies report the effect of the PART on patients on the wards and on
the patients admitted from the wards to the intensive care unit. Additional care for
surgical patients on the wards is suggested as a way of improving the management of
high-risk postoperative patients. The thesis concludes by discussing the benefits of
the ICARUS system and speculating on the direction that should be taken for
intensive care audit in the future.
Authors
Goldhill, David RaymondCollections
- Theses [3592]
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