Intoxications in Intensive Care: Cost and Bed Occupancy According to Glasgow Coma Scale
Journal Title: Türk Yoğun Bakım Dergisi - Year 2018, Vol 16, Issue 3
Abstract
Objective: Intensive care units (ICU) are the units in which critical patient care and follow-up are conducted. About 3.7-40% of ICU beds are used for intoxications. In ICU, intoxications may be mortal or can be discharged only by observation without any complication. The necessity of hospitalization of all these patients to the ICU is controversial in terms of bed occupancy and cost. In our study, it was aimed to determine the necessity and cost of hospitalization of ICU patients who were admitted to ICU with diagnosis of intoxication. Materials and Methods: This study was conducted by investigating the files of 205 intoxication patients who underwent more than 24 hours of follow-up and treatment at second and third level ICU. While patients were admitted to ICU, they were divided into two groups according to Glasgow Coma score (GCS) 15 (group=15) and below 15 (group <15). The patients’ age, gender, GCS, cause of poisoning, number of days stayed in the ICU and the need for mechanical ventilation (MV) were recorded, and the ICU costs of the groups were calculated. In addition, the cost that would be generated if the patients in group=15 were followed in the service environment rather than in the ICU was calculated. Results: Of the 205 patients examined, 145 had GCS of 15, while the GCS of 60 patients were below 15. The number of patients with GCS=15 and the intoxication case with suicide intent were higher in female gender. While the number of intoxications with cardiovascular system drugs and analgesic drugs was greater in group=15, the number of intoxications with carbon monoxide and drug substances was greater in group <15. The number of days stayed in ICU, MV requirement and ICU costs were higher in group <15. If the patients in group=15 had been followed up in the service environment, the cost would have been lower than the cost in ICU. Conclusion: GCS; it can be used to determine the necessity of hospitalization of intoxication cases into ICU due to its specificity and easy applicability. It is common belief that intoxications leading to life threatening and organ failure should be followed in second and third level ICUs. The fact that ICU beds in our country are not used according to the criteria is a big problem, which may increase the cost of use and also cause an increase in mortality. Adhering to the criteria for admitting patients to high cost units which require specialist and technological equipment such as ICUs will prevent unnecessary bed occupancy and ensure proper use of resources. According to our study, close follow-up of patients, who admitted to ICU with GCS=15, in an equipped service may reduce cost and bed occupancy.
Authors and Affiliations
Sedat Saylan, Bilal Şengü, Gülgün Elif Akçalı, Verda Dinar Tuna, Engin Ertürk
Keywords
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