Intensive Care

The intensive care population profile in Denmark before and during the first wave of the SARS-CoV-2 pandemic; a national register-based study

Original Articles, Volume 23, Issue 2, Pages 53 – 96 (2024)

Objective: To describe the change in admission rate and demographic profile of patients admitted to ICUs throughout Denmark before and during first wave of the SARS-CoV-2 pandemic.
Methods: A register-based national observational study of all patients admitted to ICU from December 2019 until April 2020, comparing ICU admission before and after lockdown.
Results: The number of admissions declined, especially in the age groups below 18 and above 70. The sex distribution and the comorbidity-level remained unchanged. The length of hospital stay prior to ICU admission increased. Overall fewer patients were admitted electively.
Conclusion: Fewer patients were admitted to ICU and waited longer for admission during the first wave of the COVID-19 pandemic.

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Applying a COVID Virtual Ward model, assessing patient outcomes and staff workload

Original Articles, Volume 20, Issue 4, Pages 249 – 308 (2021)

A COVID virtual ward (CVW) is recommended by NHS England, but ‘usual care’ outcomes have not been reported.
A retrospective study of all adults with COVID-19 attending Queen Elizabeth Hospital Birmingham between 01/06/2020-31/01/2021, assessed against CVW criteria and followed for 28 days.
Of 2301 COVID-19 patients, 571(25%) would have met CVW criteria. Of these, 325(57%) were discharged after review and 246(43%) admitted. Of admitted patients who met CVW criteria, 81% required hospital-supported therapies; 11% died. Of the 325 discharged, 13% re-presented, 9% with COVID-related symptoms, 2% required intensive care admission, and one died (0.3%).
In this comparison, discharging patients without a CVW did not lead to more re-presentations, re-admissions, ITU escalations or deaths compared to published outcomes for hospitals with a CVW.

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The changing characteristics of COVID-19 presentations. A regional comparison of SARS-CoV-2 hospitalised patients during the first and second wave

Original Articles, Volume 20, Issue 2, Pages 89-156 (2021)

Background: This study assesses COVID-19 hospitalised patient demography and outcomes during wave 1 and wave 2, prior to new variants of the virus.

Methods: All patients with a positive SARS-CoV-2 swab between 10th March 2020 and 5th July 2020 (wave 1) and 1st September 2020 and 16th November 2020 (wave 2) admitted to University Hospitals Birmingham NHS Foundation Trust were included (n=4856), followed for 28 days.

Results: Wave 2 patients were younger, more ethnically diverse, had less co-morbidities and disease presentation was milder on presentation. After matching for these factors, mortality was reduced, but without differences in intensive care admissions.

Conclusion: Prior to new SARS-CoV-2 variants, outcomes for hospitalised patients with COVID-19 were improving but with similar intensive care needs.

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Acute, non-COVID related medical admissions during the first wave of COVID-19: A retrospective comparison of changing patterns of disease

Original Articles, Volume 19, Issue 4, Pages 173 – 252 (2020)

COVID-19 may have altered the case-mix of non-COVID acute medical admissions. Retrospective analysis of acute medical admissions to University Hospitals Birmingham NHS Foundation Trust, showed that medical admissions decreased in April 2020 compared to April 2019. The proportion of young adults, non-cardiac chest pain, musculoskeletal conditions and self-discharges decreased. The proportion of admissions due to alcohol misuse, psychiatric conditions, overdoses and falls increased. There were a higher number of patients admitted to ICU and greater inpatient mortality but not once COVID diagnoses were excluded. There was a significant change in hospitalised case-mix with conditions potentially reflecting social isolation increasing and diagnoses which rarely require hospital treatment, reducing. This analysis will help inform service planning.

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Direct and delayed admissions to ICU in older medical patients

Original Articles, Volume 17, Issue 2, Pages 57 – 116 (2018)

Abstract

The aims of this retrospective cohort study were to retrieve characteristics and outcomes of older (65+) medical patients who are directly admitted to ICU from the ED and to compare these with those admitted to ICU from a ward.

Of 1396 patients, 21 (1.5%) were directly admitted to ICU and 54 (3.9%) after a delay. Blood pressure was lower and respiratory rate higher in the direct than in the delayed group. The direct group had lower mortality (28-day: 19.0 vs.

38.9%, p=0.14; 1-year: 42.9 vs. 66.7%; p=0.06), shorter length-of-stay and returned more frequently to independent living than the delayed group.

Only a fraction of older patients are admitted to ICU; directly admitted patients tend to have better outcomes.

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Long-term health related quality of life in patients with sepsis after intensive care stay: A systematic review

Research Audit and Clinical Practice, Volume 16, Issue 4, Pages 153 – 212 (2017)

Abstract

Sepsis is a major health care issue and sepsis survivors are often confronted with long-term complications after admission to the intensive care unit (ICU) which may negatively influence their health related quality of life (HRQOL). This study aimed to systematically evaluate the outcome in terms of HRQOL in patients with sepsis after ICU discharge.

A literature search was conducted in the bibliographic databases PubMed, EMBASE, and CINAHL, including reference lists of published guidelines, reviews and associated articles.

Sixteen studies were included, thirteen (81.3%) reported that sepsis survivors suffer from impaired HRQOL in physical and mental domains which persist from months to years after a sepsis episode.

More focus on improving long-term outcomes for patients surviving sepsis and the ICU is needed.

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Into the Night: Factors affecting response to abnormal Early Warning Scores out-of-hours and implications for service improvement

Research Audit and Clinical Practice, Volume 13, Issue 2, Pages 53 - 100 (2014)

Abstract

Background: Early Warning Scores alert staff to preventable deterioration. Raised scores should lead to escalation of care.

Aims: To establish response of staff to patients scoring National Early Warning Score (NEWS) of six or above and to identify patient and environmental factors affecting escalation by nursing staff.

Methods: Service evaluation with prospective review of patient records of 118 beds on four medical wards during 20 night-shifts.

Results: During 2360 observed bed days 109 patients triggered NEWS >=6 at least once during the observation period. Nursing staff escalated only 18 (17%) of these patients; nearly all of them had predefined chronic health conditions, the majority fulfilled criteria for frailty. Despite their higher 30-day mortality patients with COPD had lower escalation rates. Additionally wards that had more patients with a NEWS >=6 had lower escalation rates.

Conclusion: Alarm fatigue and clinical judgement of staff might result in deviation from escalation protocols.

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