Báo cáo y học: Recently published papers: Delivery, volume and outcome – what is best for our patient

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Recently published papers: Delivery, volume and outcome – what is best for our patient?
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Báo cáo y học: " Recently published papers: Delivery, volume and outcome – what is best for our patient" Available online http://ccforum.com/content/11/4/155CommentaryRecently published papers: Delivery, volume and outcome – whatis best for our patient?Lui G Forni1,21Department of Nephrology & Critical Care, Worthing General Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH, UK2Brighton & Sussex Medical School, University of Sussex, Brighton, East Sussex BN1 9PX, UKCorresponding author: Lui Forni, Lui.Forni@wash.nhs.ukPublished: 14 August 2007 Critical Care 2007, 11:155 (doi:10.1186/cc6082)This article is online at http://ccforum.com/content/11/4/155© 2007 BioMed Central LtdSee related research by Peelen et al., http://ccforum.com/content/11/3/R40Abstract Evaluation III scores (60.5 versus 49.7), higher intensive care unit (ICU) mortality (14% versus 8%) and higher hospitalMany studies have demonstrated that prompt appropriate treat- mortality (22% versus 14%). The length of stay was alsoment for the critically ill patient improves outcome. Moving patients longer in terms of both ICU bed days and hospital bed days.to the best place for instituting care, however, is not alwaysassociated with improved outcome. Recent studies on delivering These results are in keeping with several other studies [2,3].patients to the best place for treatment as well as further work on When stratified by disease severity using the Acutethe effects of volume are discussed. Finally, a large retrospective Physiology and Chronic Health Evaluation III model, however,cohort study comparing outcomes of patients treated with continu- the crude mortality differences were less striking, with noous venovenous haemofiltration or intermittent haemodialysis is statistical differences observed. What did remain significantlyoutlined. different was the cost of treatment. On average, a patient transferred to the ICU from outside the institution cost about “Nothing is permanent but change” $10,000 more per admission. Somewhat surprisingly, this difference was principally confined to the group with the Heraclitus, circa 500 BC lowest predicted mortality – the reasons for which remain unclear. Does this mean that transferring patients has noFor those of us practicing in the United Kingdom, the National impact other than financial? Probably not, as case mix alsoHealth Service is approaching its 60th birthday and, far from plays a significant role – an earlier study on medical ICUbeing pensioned off, there is much political will to change the patients demonstrated that, even after accounting for diseaseway healthcare is being delivered in a radical fashion. This severity, transferred patients had a significantly higherreinvention of the National Health Service is being applied mortality rate [4]. This has also been backed up by findings inacross the board, including the critical care arena, and an Europe [5].often-used phrase is that of ‘reconfiguration’ of services. Thiswill probably lead, in time, to fewer critical care units in Following on from this study is a paper from Chalfin andEngland and to more patients being transferred between colleagues, who examined the impact of a delay in transfer ofhospitals. critically ill patients from the A&E department (or the emergency department, if you prefer) to the ICU using cross-Two papers published in Critical Care Medicine therefore sectional analysis of the multicentre US Project Impactmake interesting reading for those of us swept up in this Database of ICU patients [6]. Patients were divided into twomaelstrom. Golestanian and colleagues performed a cohort groups: those remaining in the A&E department for longerobservational study examining the effects of interhospital than 6 hours (referred to as ‘boarding’ patients), and thosetransfers on resource utilisation and outcomes at a tertiary patients transferred in under 6 hours. The 6-hour value wascare referral centre in the USA [1]. They compared patients selected as it correlates with the 5.8-hour period reported astransferred from other hospitals with those admitted ‘in- the mean time to transfer from the A&E department to an ICUhouse’ from the A&E department or the wards. The patients bed in American hospitals that report overcrowding in thetransferred had higher Acute Physiology and Chronic Health A&E department. The dat ...