Intensive Care Unit- Comparative Audit

Shizan Hamid Feroz; Aamer Mehmood Malak; Syed Hamid Ali Shah; Nighat Zaman

Background: To compare mortality audit of an intensive care unit , before and after implementation of different management and academic improvement measures. Methods: In this retrospective study , mortality audit of intensive care unit (ICU) for two consecutive years was done. Total mortality and specialty wise mortality for respective year were recorded and then this total morality rate and specialty wise mortality rate of each year was compared with respective mortality rate of the other year . Number of ICU trained nurses was increased from initial one staff nurse for eight beds to three staff nurses for same number of beds. Steps were taken for local training of these nurses.Full time intensivist was made available for ICU which was previously being managed by a part time physician. Similarly changes were made in physician staffing pattern and with the help of different specialty heads registrars and trainees were made accountable for their patients in ICU. Changes in organizational characteristics of ICU were also made. Written specific instructions (SOPs) for attending the patients in specific situations were made and implemented. Specific Job descriptions and standing operating procedures for different situations and for use of different equipments were made and implemented. Different record systems for recording patient's data were introduced.Different ICU bundles were introduced and implemented. At the end of year 2012 a retrospective mortality audit of our ICU for year 2011 and year 2012 and compared the results to know what difference has been made before the complete implementation of our efforts and after that. Results: Total number of admissions in ICU in year 2011were 582 out of which 152 died giving overall mortality rate of 26.11%. Highest mortality rate was observed in medical patients(33.0%. Surgical patient's mortality was 21%. A total of 91 patients were placed on ventilatory support in 2011 of which 31 died giving mortality of 34.06% and contributing 15.63% to total bed occupancy and 20.39% to total mortality. Total number of admissions in ICU in year 2012 were 486 out of which 90 died giving overall mortality rate of 18.50%.Total of 102 patients were placed on ventilatory support in 2012 of which 28 died giving mortality of 27.45%,contributing 20.98% to total bed occupancy and 31.11% to total mortality. Mortality rate dropped significantly from 26.11% in 2011 to 18.50% in 2012. Mortality rates of individual group of patients has also dropped significantly. Surgical patients' mortality dropped from 21% to 13.5% in respective years. Medical patient's mortality has dropped from 33% to 22.50%, Gyane/Obs from 13.79% to 08.33% and ventilator support patients from 26.11% to 18.50% in respective years. Conclusion: Better intensive care management at administrative and academic levels can result in significant reduction in overall mortality of ICU as well specific patient groups mortality .