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S. Ridley - One of the best experts on this subject based on the ideXlab platform.
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sequential organ scoring as a measure of effectiveness of care in the High Dependency Unit
Anaesthesia, 2001Co-Authors: R J De Silva, Aileen J Anderson, H Tempest, S. RidleyAbstract:High-Dependency Units are of benefit to patients and to the associated intensive 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. The median Logistic Organ Dysfunction System score on admission was 3. The mean duration of stay was 4.3 days, and the median Logistic Organ Dysfunction System score on day 4 was 1. Sixty-six per cent of patients had a lower Logistic Organ Dysfunction System score at discharge. In the remaining patients, the commonest reason for no change or a Higher Logistic Organ Dysfunction System score was renal dysfunction. High-Dependency care is effective in the majority of patients in terms of improved physiological status and most patients were discharged with minor physiological dysfunction. This level of physiological dysfunction could be applied as a discharge threshold. Poorer 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.
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an assessment of the staffing level required for a High Dependency Unit
Anaesthesia, 2000Co-Authors: M Garfield, R Jeffrey, S. RidleyAbstract:High-Dependency Units are increasing in number and becoming an ever more important part of a hospital's facilities. The optimum staffing ratio is unknown, but the Department of Health and the Intensive Care Society recommend a level of one nurse to two patients. We recorded Therapeutic Intervention Scoring System-28 scores and Nurse Dependency Scores for all admissions to our adult, general High-Dependency Unit over 7 months. We found a weak correlation between the nurse Dependency score and the Therapeutic Intervention Scoring System-28 score. The median Therapeutic Intervention Scoring System-28 score was 23 points (interquartile range 19–26), and the median Nurse Dependency Score was 1.0. These results are approximately two-thirds of those for European intensive care Units. We conclude that a nurse-to-patient ratio of 1 : 2 may be insufficient for an adult general High-Dependency Unit, and would recommend a nurse-to-patient ratio of 2 : 3.
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complications in the first 48 hours after major surgery a comparison between the general ward and High Dependency Unit
Clinical Intensive Care, 2000Co-Authors: G Vijaykumar, T Kooner, S. RidleyAbstract:Objective: To compare the incidence of complications in the first 48 h after major surgery between patients managed on the general ward and High Dependency Unit (HDU). Design: Prospective study. Setting: A six-bed adult HDU in an 800-bed district hospital. Patients: 500 consecutive patients following major surgery. Results: 384 (76.8%) of the patients were returned to the general ward while 116 (23.2%) were admitted to the HDU. The mean Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score for patients admitted to the HDU was Higher than that for patients returned to the general ward (37.5 vs. 30.8). This resulted from both a Higher mean physiological score (22.1 vs. 18.5, p<0.001) and a Higher mean operative severity score (15.4 vs. 12.3, p<0.001) for patients admitted to HDU. The median number of complications per POSSUM point for HDU patients was 0.073 while that for general ward patients was 0.056 (p<0.001). Using analysis of covariance to co...
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the impact of a High Dependency Unit on the workload of an intensive care Unit
Anaesthesia, 1998Co-Authors: G Dhond, S. Ridley, M PalmerAbstract:While there has been recent support for High-Dependency Unit development, there are few data reporting the impact of such development on existing critical care facilities. Therefore the aim of this study was to examine the workload and capacity constraints of an adult general intensive care Unit before and after the development of an adjacent High-Dependency Unit. Following the opening of the High-Dependency Unit, the total number of patients admitted increased by 49%. On the High-Dependency Unit, more elderly patients were admitted for longer and more frequently following midweek elective surgery. On the intensive care Unit, patients' initial severity of illness was lower and their duration of admission decreased; fewer patients were admitted directly from the general wards. The financial benefits of High Dependency care may be eroded by the increased use of the critical care services.
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Intermediate carePossibilities, requirements and solutions
Anaesthesia, 1998Co-Authors: S. RidleyAbstract:The inadequate supply of intensive care facilities has focused interest on intermediate care as a means of bridging the gulf between the level of support available in the intensive care Unit and the general ward. However, few hospitals have developed intermediate care, in the form of High-Dependency care Units, and little information exists concerning the use or potential of such areas. Therefore, this review proposes to cover the definition of intermediate care and to discuss some of the possible reasons why intermediate care is now believed necessary. The capabilities of intermediate care for selected groups of patients and the treatment modalities offered are described. The present provision of High-Dependency care in the United Kingdom is discussed and the methods for estimating the required size of a High-Dependency Unit are outlined. The impact of a High-Dependency Unit on the workload of the intensive care Unit and the potential cost saving of managing such patients in an intermediate care area are illustrated.
L De Cossart - One of the best experts on this subject based on the ideXlab platform.
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value of a surgical High Dependency Unit
British Journal of Surgery, 1999Co-Authors: Helen Jones, R Coggins, J Lafuente, L De CossartAbstract:Background: A minority of hospitals in the UK have a High-Dependency Unit (HDU). One reason for this is a lack of evidence supporting its benefit. This study sought to compare the outcomes of patients undergoing major abdominal surgery with regard to HDU utilization. Methods: Data were collected prospectively from two groups of patients over 10 months. Patients in the no-HDU group underwent major abdominal surgery in a hospital without an HDU and returned to a general surgical ward. The other group was managed initially in an HDU. Data collected included Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) scores, complications, deaths and length of stay. Results: Physiological and operative scores as calculated on the RAJIS POSSUM software were similar in both groups. The HDU group comprised 121 patients. Sixty-four developed a complication whereas 58·81 were expected to, giving an observed: expected (O: E) ratio of 1·09. Sixteen deaths occurred and 14·54 were expected (O: E ratio 1·10). Some 50 per cent stayed in hospital longer than was predicted. The no-HDU group comprised 71 patients. Fifty-nine developed a complication compared with 33·82 expected (O: E ratio 1·74). Ten deaths occurred, whereas 8·88 were expected, giving an O: E ratio of 1·13. Some 63 per cent stayed longer than predicted. The O: E ratios for morbidity were significantly different (P < 0·0005). The complications that occurred more frequently in the absence of an HDU were chest infection, arrhythmias and hypotension. Conclusion: Postoperative management on an HDU was associated with fewer cardiorespiratory complications. There was no difference in mortality rate but there was a trend towards shorter hospital stay. © 1999 British Journal of Surgery Society Ltd
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use of a general surgical High Dependency Unit in a district general hospital the first 10 years
Journal of The Royal College of Surgeons of Edinburgh, 1998Co-Authors: R Coggins, C H Parkin, L De CossartAbstract:The High Dependency Unit (HDU) is a facility that is an essential component of any surgical Unit. This paper reviews the development of a general surgical HDU managed by surgeons over a decade, with analysis of activity from 1991 to 1996. The general surgical workload has increased during the 10-year period, and the case-mix has become richer by an increase in vascular surgery. The HDU provides essential post-operative care to major surgical patients and minimizes the cancellation of aortic operations without placing an extra burden on the intensive care services. The HDU centralises sick patients, facilitating their care, and provides a learning environment for trainee surgeons.
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comparison of possum with apache ii for prediction of outcome from a surgical High Dependency Unit
British Journal of Surgery, 1992Co-Authors: D R Jones, G P Copeland, L De CossartAbstract:POSSUM and APACHE II scores from 117 consecutive admissions to a High-Dependency Unit after major surgery were correlated with 30-day morbidity and mortality rates. Thirteen patients (11 per cent) died and 59 (50 per cent) developed a postoperative complication. Receiver-operating characteristic curve analysis showed POSSUM to have good predictive value for mortality (area under curve 0.75) and morbidity (area under curve 0.82). APACHE II scores had a significantly inferior predictive value for mortality (area under curve 0.54) (P < 0.002). POSSUM was superior to APACHE II in prediction of mortality in patients admitted to a High-Dependency Unit after general surgery. Prediction of postoperative complications by POSSUM is accurate and may be useful for audit.
A Linsley - One of the best experts on this subject based on the ideXlab platform.
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immediate extubation and epidural analgesia allow safe management in a High Dependency Unit after two stage oesophagectomy results of eight years of experience in a specialized upper gastrointestinal Unit in a district general hospital
BJA: British Journal of Anaesthesia, 2003Co-Authors: M V Chandrashekar, Mark Irving, J Wayman, S A Raimes, A LinsleyAbstract:Background. The perioperative management of two-stage oesophagectomy has not been standardized and the prevailing practice regarding the timing of extubation after the procedure varies. This audit has evaluated the outcome, in particular the respiratory morbidity and mortality, after immediate extubation in patients who have had thoracic epidural analgesia. Methods. All the patients who underwent two-stage oesophagectomy by a single specialist upper gastrointestinal surgeon were recorded both retrospectively (1993–1999) and prospectively (1999–2001). Physical characteristics, comorbid factors, anaesthetic management and postoperative events were recorded on a computer database. Analysis was undertaken to evaluate the morbidity and mortality, in particular the need for reventilation and transfer to the ITU. Results. Seventy-six patients underwent two-stage oesophagectomy between 1993 and 2001. Seventy-three (96%) patients were extubated in theatre and transferred to a High-Dependency bed. Three were ventilated electively and extubated within 36 h and made an uncomplicated recovery. Seven (10%) of the immediately extubated patients subsequently needed admission to the ICU and reventilation. Sixty-seven patients had effective epidural analgesia and nine needed i.v. morphine by patient-controlled analgesia. The 30-day or in-hospital mortality was 2.6% (2 of 76). A further two patients died within 90 days, but after discharge. Respiratory complications were responsible for half of the overall morbidity (44.7%). Respiratory failure occurred in 6.5% (5 of 76) and acute respiratory distress syndrome in 2.6% (2 of 76). Both the in-hospital deaths occurred in patients requiring reventilation and resulted from respiratory complications. The following factors were found to be significant in the reventilated patients: duration of one-lung ventilation; forced expiratory volume in the first second; and ratio of forced expiratory volume in the first second/forced vital capacity. Conclusion. Immediate extubation after two-stage oesophagectomy in patients with thoracic epidural analgesia is safe and associated with low morbidity and mortality. Patients can be managed in a High-Dependency Unit, thus avoiding the need for intensive care. This has cost-saving and logistical implications. Br J Anaesth 2003; 90: 474–9
M Stark - One of the best experts on this subject based on the ideXlab platform.
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g505 p bronchiolitis a comparative analysis of High Dependency Unit hdu admissions and ward admissions
Archives of Disease in Childhood, 2019Co-Authors: N Bee, E Best, M StarkAbstract:Background Our tertiary paediatric centre has approximately 8300 admissions a year. Bronchiolitis is a common illness requiring admission but only 10% require High Dependency care (HDU). Is there a difference between those patients requiring HDU and those who do not? Aims To complete a retrospective comparative case analysis comparing demographics and features of illness between the two groups to determine any relationships to HDU admission. Methods All bronchiolitis admissions (n=509) from September 2016 to April 2017 were identified in patients up to 14 months of age. There were 53 admissions to HDU. Forty nine had complete electronic clinical records available to review. Fifty admissions receiving ward level care were randomly selected for comparison. Statistical analysis was completed using descriptive statistics, the Independent T test and Pearson’s Chi Squared. Results Table one shows the comorbidities. A significantly greater number of patients with a cardiac abnormality required admission to HDU. Admission to hospital earlier (days of coryza), Higher respiratory rate and the need for oxygen were statistically significantly related to HDU admission. There was no viral aetiology that related to HDU admission when compared with the ward cohort. Conclusion The only comorbidity identified that was related to HDU admission was a cardiac abnormality. There was no statistical relationship with prematurity, chronic lung disease, home oxygen or neuromuscular conditions identified. Earlier admission in illness, Higher respiratory rate and oxygen requirement could all be used as surrogate markers for disease severity and were more prominent in the HDU group.
E G L Wilkins - One of the best experts on this subject based on the ideXlab platform.
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outcome of varicella pneumonitis in immunocompetent adults requiring treatment in a High Dependency Unit
Journal of Infection, 2001Co-Authors: A M Jones, N Thomas, E G L WilkinsAbstract:Abstract Objectives : The incidence of varicella infection is increasing in adults, where primary pneumonitis is the main complication. Little information exists concerning treatment of those patients who require admission to a High Dependency Unit (HDU) facility. A study was performed to examine the risk factors for developing varicella pneumonitis (VP), to document disease progression and assess prognosis for patients with VP requiring HDU admission. Methods : A 10-year retrospective casenote review of patients admitted to the Regional Infectious Diseases Unit HDU. Varicella pneumonitis (VP) was defined as diffuse nodular shadowing on a chest X-ray (CXR) of a patient with a classical chickenpox rash. Severe pneumonitis was defined as an hypoxaemia index (pO2 in mmHG/FiO2) of less than 150 at any time during hospital stay. All patients were treated with intravenous acyclovir at a dose of 10mg/kg. Results : A total of 33 patients were admitted to the HDU with VP over the study period, 30 were included in the study. Annual admission rates remained constant. Most patients (76.7%) had at least one recognised risk factor for severe VP: smoking 18/30, pregnancy 9/30, chronic lung disease 7/30. Twelve (40%) patients had severe VP, eight (26.7%) required assisted ventilation. The presence of greater than one risk factor (p Conclusions : The prognosis for severe adult VP with current available treatment is good. The only predictor on admission for severe VP is the presence of more than one recognised risk factor for developing VP.