Immediate Post Discharge Outcomes of Patients From The Adult Intensive Care Unit at Bugando Medical Centre
Deborah Forden Madyedye [Female]
Immediate Post Discharge Outcomes of Patients From The Adult Intensive Care Unit at Bugando Medical Centre - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] 2019 - 59 Pages Includes Idex
Abstract:
Background: ICU illness often leads to prolonged stays, which can have both acute and long-term consequences for patients that survive. In hospital mortality and functional status of these patients at discharge from ICU and the hospital is a significant concern in Sub Saharan Africa.
Aim: The aim of this study was to assess the immediate post discharge outcomes of patients discharged from the Adult Intensive Care Unit at Bugando Medical Centre (BMC), MwanzaTanzania.
Methods: This was a hospital based follow-up study conducted at BMC-AICU from March 2019 to June 2019. Patients aged 18 years and above who were discharged from AICU to the wards were enrolled in this study. Social demographic data, referral speciality, duration of ICU stay indication of ICU admission, intervention done in ICU/OR and complication acquired in ICU was noted. The functional status before AICU admission and at discharge from AICU derived from WHO disability assessment score was noted. These patients were followed up for in hospital mortality till discharge from hospital to home. Predictors of in-hospital mortality were determined. Data were analysed using STATA software version 13.
Results: A total of 191 patients discharged from AICU to hospital (adult ICU survivors) were recruited during the study period with the median age of 40 (IQR: 28 – 61) years. Of these females were 105 (55.0%) and the median hospital stay of post discharge was 7 [IQR: 4 – 12] days. Of the 191 adults ICU survivors, in hospital mortality was observed in 23 (12.0%) patients. The leading cause of mortality was sepsis 7 (30.4%) and majority of patients who died in hospital had a median in-hosptal stay of 8[IOR: 3 – 17] days after ICU discharge. There was significant deterioration of functional status post AICU discharge as majority of ICU survivors at the day of ICU discharge had no ability to undertake activities of daily living 171 (89.5%) and 148(77.49%) respectively were not able to wash and eat by themselves without assistance during their discharge from ICU. Post operative care as an indication for ICU admission (OR 6.6; 95% CI 1.45 – 29.6; pvalue=0.014) was observed to be an independent predictor of in-hospital mortality in which patients admitted for post operative care had higher mortality whereas medical history of HIV on ART was found to be protective factor (OR 0.05; 95%CI 0.01 – 0.42; p – value = 0.006).
Conclusion: The in-hospital mortality among adult discharged from AICU to hospital wards was observed in one out of eight patients. There was significant imparement in functional status among ICU survivors. Post operative care as an indication for ICU admission and medical history of HIV on ART were independent predictors of in-hospital mortality. We recommend study to be done on the validation of delay of ICU discharge by atleast 48 hrs to improve outcome, ICU team be reviewing high risk patients in the ward after ICU discharge and there should be a process for re-admission for those who worsen in the ward post ICU discharge.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Anaesthesia and Critical Care
Immediate Post Discharge Outcomes of Patients From The Adult Intensive Care Unit at Bugando Medical Centre - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] 2019 - 59 Pages Includes Idex
Abstract:
Background: ICU illness often leads to prolonged stays, which can have both acute and long-term consequences for patients that survive. In hospital mortality and functional status of these patients at discharge from ICU and the hospital is a significant concern in Sub Saharan Africa.
Aim: The aim of this study was to assess the immediate post discharge outcomes of patients discharged from the Adult Intensive Care Unit at Bugando Medical Centre (BMC), MwanzaTanzania.
Methods: This was a hospital based follow-up study conducted at BMC-AICU from March 2019 to June 2019. Patients aged 18 years and above who were discharged from AICU to the wards were enrolled in this study. Social demographic data, referral speciality, duration of ICU stay indication of ICU admission, intervention done in ICU/OR and complication acquired in ICU was noted. The functional status before AICU admission and at discharge from AICU derived from WHO disability assessment score was noted. These patients were followed up for in hospital mortality till discharge from hospital to home. Predictors of in-hospital mortality were determined. Data were analysed using STATA software version 13.
Results: A total of 191 patients discharged from AICU to hospital (adult ICU survivors) were recruited during the study period with the median age of 40 (IQR: 28 – 61) years. Of these females were 105 (55.0%) and the median hospital stay of post discharge was 7 [IQR: 4 – 12] days. Of the 191 adults ICU survivors, in hospital mortality was observed in 23 (12.0%) patients. The leading cause of mortality was sepsis 7 (30.4%) and majority of patients who died in hospital had a median in-hosptal stay of 8[IOR: 3 – 17] days after ICU discharge. There was significant deterioration of functional status post AICU discharge as majority of ICU survivors at the day of ICU discharge had no ability to undertake activities of daily living 171 (89.5%) and 148(77.49%) respectively were not able to wash and eat by themselves without assistance during their discharge from ICU. Post operative care as an indication for ICU admission (OR 6.6; 95% CI 1.45 – 29.6; pvalue=0.014) was observed to be an independent predictor of in-hospital mortality in which patients admitted for post operative care had higher mortality whereas medical history of HIV on ART was found to be protective factor (OR 0.05; 95%CI 0.01 – 0.42; p – value = 0.006).
Conclusion: The in-hospital mortality among adult discharged from AICU to hospital wards was observed in one out of eight patients. There was significant imparement in functional status among ICU survivors. Post operative care as an indication for ICU admission and medical history of HIV on ART were independent predictors of in-hospital mortality. We recommend study to be done on the validation of delay of ICU discharge by atleast 48 hrs to improve outcome, ICU team be reviewing high risk patients in the ward after ICU discharge and there should be a process for re-admission for those who worsen in the ward post ICU discharge.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Anaesthesia and Critical Care