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June 2024 (Volume 6) Complex surgical patients not admitted to critical care A QASM assessor stated: ‘We recognise futility when it comes to operate or not, or ICU or not, but it is important to link the two in the surgeon's plan. Even preoperatively, if ICU is consulted, a joint decision can sometimes be made to counsel the patient and family to embark on nonoperative management, or even palliation.’
PURPOSE:
To determine if Queensland assessors considered that medical care of the surgical patient could have been better had the patient been admitted to a critical care unit - either a high dependency unit (HDU) or intensive care unit (ICU) (jointly termed ICU in this report).
BACKGROUND: ICUs provide peri-operative specialised observation, medical care and end-organ support when recovery with a reasonable quality of life is considered likely. ICU care is an expensive and finite resource; admissions may be declined if meaningful recovery is considered unlikely or if beds are unavailable. In Queensland in 2021-22, there were 8.1 funded beds per 100,000 population1. Figure 1. Declined admissions to ICU (median and IQR) by region, 2021/2022 12%
Declined Admissions
10%
8%
6%
4%
2%
0%
NSW (35)
QLD (27)
SA (10)
VIC (24)
WA (5)
NZ (13)
AUS (109)
Total (122)
Note: Data from 122 contributing ICUs. ACT (3), NT (2) and TAS (3) excluded for individual reporting to avoid identification of individual ICUs. Source: Figure 18, Intensive Care Resources and Activity Report 2021/20221
METHODS: QASM reviewed surgical mortality data for patients who died in hospital between January 2018 and December 2023.
12%