A prospective cohort study of 6-month mortality in a community hospital experiencing a gradual reduction in critical care services.

OBJECTIVE: To analyse the effect of reduction of critical care services on admissions, resource consumption and outcome.

DESIGN: Observation outcome study with analysis of patient data collected prospectively during 1993, 1995 and 1997.

SETTING: High dependency and intensive care unit (HDU/ICU) of a community hospital serving a population of 168,000. The number of beds decreased from 12 (1993), to 10 (1995) and to 8 (1997) with concomitant decrease in staff.

PATIENTS AND PARTICIPANTS: Three patient cohorts admitted to the HDU/ICU during 1993, 1995 and 1997.

MEASUREMENTS AND RESULTS: Admissions were classified into recovery room care or critical care admissions and stratified according to workload (Levels I-IV). Illness severity scores of critical care admissions were recorded according to the APACHE II system. Mortality data were acquired from a national database. The total number of admissions to the unit did not change over the years. Length of stay decreased significantly over the years. Standardised mortality rates based on mortality within 30 days of discharge from the HDU/ICU were 1.17 (95% confidence interval 0.96-1.43) for critical care admissions during 1993, 0.86 (0.70-1.06) for 1995 and 0.98 (0.79-1.22) for 1997. Survival 180 days after discharge from the HDU/ICU did not differ significantly over the years.

CONCLUSIONS: The results suggest that an excess of resources were used in critical care services during 1993 and 1995. Reduction of HDU/ICU beds by 30% from 7.1 to 4.8 beds/100,000 was not associated with increased 6-month mortality of the patients admitted.