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Chulalongkorn Medical Journal

Abstract

Introduction : Only recently that chronic diseases have been found increasing dueto longer life spans of human beings. Meanwhile, the development ofmedical technology has been saving many lives. Nevertheless, it alsoartificially prolongs the lives terminal patients. In actual situations,there have been widely scarce of ICU cares or negative balance indemand and supply of ICU cares. A cause of the scarcity might beunintentional provision of ICU for caring at the end of life. However,there has been no investigation on the nature of care in ICUs of KingChulalongkorn Memorial Hospital. The authors considered if therehave been data regarding the nature of cares in term of resourceallocation in intensive care units, it would be useful for future ICUmanagementObjectives : (1) To explore lengths of stay in ICU of King Chulalongkorn MemorialHospital;(2) To explore proportions in term of number and time consumption ofnon-survivors and survivors in ICU of King Chulalongkorn MemorialHospital.Research design : A retrospective study.Patients : The target of population survey is adult patients (age>15 years) whowere admitted in ICUs at King Chulalongkorn Memorial Hospital fromJanuary to December, 2007.Methods : Data were collected in term of numbers of the target population basedon the formal records from the department of registration and reviewedICU medical records. Then, number of the target group, i.e., survivors,and non-survivors were counted. The length of stay (LOS) in ICU ofthe patients, underlying conditions, medical treatment anddemographic data of both groups of patients were categorized andrecorded in numbers. Descriptive statistics: percentage was used fornumerical and categorical variables; mean and standard deviationwere used for length of stay in ICU. As for inferential statistics, Chisquarewas used for comparison between the survivors and nonsurvivors.Results : Total target population was 2,828 patients. Three hundred and elevenpatients died and the overall mortality rate was 10.99%. As forthe overall admissions, the longer average LOS groups were in MED1ICU (160.27 ± 259.28 hr.). The shortest average LOS was in Obstetricsand Gynecological ICU (40.95 ± 47.46 hr). Overall the proportion oftime consumption of the survivors and non-survivors were 3:1.The overall proportion of number of survivors and non- survivors were9:1. There have been differences of these proportions among differenttypes of ICU. The proportions of number of survivors and non-survivorsof MED1 and 2 ICU were 1.74:1 and 0.98:1 respectively.Discussion : The overall proportion of number of survivors and non-survivors of 9:1indicated the nature of ICU cares at King Chulalongkorn Hospital werenot spent as places for patients at the end of lives. However, therehas been an earlier study in the US that 1 in 5 patients did not survivedin some intensive cares. These might possibly imply that the intensivecare units would become places for patients at the end of lives inthe near future. The main findings from this study showed thatthe medical ICUs tended to be places for caring patients at the end oflives. Other findings such as CPR action or the very short period ofadmission, might imply lack of end-of-life care applicationConclusion : The research question whether the ICUs are places for caring patientsat the end of lives was replied. That was ICUs at King ChulalongkornMemorial Hospital were normally not allocated for those who at the endof lives. Because the overall proportion of number of survivors andnon-survivors was less than of the western report and the overall timeconsumption of survivors was higher than of non-survivors. However,the medical ICUs tended to be places for caring patients at the end oflives. Some remarkable findings implied some problems of decisionmakings regarding end-of-life care that might lead ICUs to be placesfor caring patients at the end of lives. The in-depth study should befurther investigated.

Publisher

Faculty of Medicine, Chulalongkorn University

First Page

25

Last Page

37

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