scottish intensive care society audit group, annual report 2003. note from scottish intensive care...

Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk

Note from Scottish Intensive Care Society Audit Group

• There follows a series of figures & tables taken from the Annual Report 2003.

• Not all tables are suitable for inclusion.

• To evaluate this method of publication of our results, we

would be grateful to receive feedback as to the value of the

Annual Report, this presentation and the context in which

either have been used by you.

• Email responses to [email protected].

Thank you.


Figure 1. Annual admission rates to Scottish ICUs, 1995 - 2001: a) in cohort of 20 units contributing throughout and b) all

participating units.

5000

5500

6000

6500

7000

7500

8000

8500

9000

1995 (22) 1996 (22) 1997 (23) 1998 (25) 1999 (24) 2000 (24) 2001 (26)

Year (participating units that year)

N

Cohort of same 20 ICUs All participating units


Figure 2. Trends in bed occupancies (%) in Scottish ICUs, 1999, 2000 & 2001.

0

20

40

60

80

100

120

140

VO

L*

^

DG

RI*

Wis

haw

*^

SR

I*

VH

K*

QM

H*

HM

*^

PR

I*

SH

Ay

r*

RM

*

St.

J*

WIG

CH

*

RA

H*

MK

VIG

SG

H

FD

RI*

^

NW

RIE

GR

I

WG

H

IRH

*

AR

I

BG

H*

Unit

%

1999 2000 2001


Figure 3. Scotland: ICU bed occupancy 1996-2001.

10

20

30

40

50

60

70

80

90

100

Occupancy(%)

1996 1997 1998 1999 2000 2001

Year


Figure 4. Trends in annual admission rates: 1999-2001.

050

100150200250300350400450500550600650700750

IRH

*

PRI*

VO

L*^

SRI*

VH

K*

SGH

Ayr

*

St. J

*

SH

RA

H*

MK

DG

RI*

BG

H*

RM

*

QM

H*

NW

CH

*

VIG

WG

H

GR

I

WIG

Wis

h*^

HM

*^

FDR

I*^

AR

I

RIE

Unit

Ad

mis

sion

s (N

)

1999 2000 2001


Figure 5. Trends in Scottish ICU winter bed occupancies: December - March.

0

10

20

30

40

50

60

70

80

90

100

110

1996-7 1997-8 1998-9 1999-00 2000-01 2001-02

Year

%

Dec Jan Feb March


Figure 6. Trends in monthly bed occupancies (all units): 1999-2001.

0

10

20

30

40

50

60

70

80

90

100

110

Jan Feb March April May June July Aug Sept Oct Nov Dec

Month

%

1999 2000 2001


Figure 7. Length of ICU stay, 2001 (Mean & Median).

0

1

2

3

4

5

6

7

8B

GH

*

HM

*^

CH

*

RA

H*

VO

L*^

Wis

haw

*^

DG

RI*

VIG

PR

I*

WIG

St.

J*

FD

RI*

^

QM

H*

Ayr

*

VH

K*

IRH

*

RIE

RM

*

SH

SR

I*

MK

*

AR

I

GR

I

NW

SG

H

WG

H

Unit

Day

s

Unit Median Unit Mean Scottish Median Scottish Mean


Figure 8. Length of ICU stay, 2001 (median and inter-quartile range). Scottish median = 2 days, IQR 0.9-5.2.

0

2

4

6

8

10

12

MK

*

RM

*

St.

J*

BG

H*

CH

*

RA

H*

VIG

DG

RI*

VH

K*

RIE

QM

H*

PR

I*

Ayr

*

AR

I

IRH

*

SH

WIG

VO

L*^

Wis

haw

*^

SR

I*

GR

I

HM

*^

FD

RI*

^

NW

SG

H

WG

H

Unit

Day

s

LOS (Median, d)


Table 4. Summary demographic characteristics, 2001.

All admissions

Admissions (n) 8629Operative (%) 42Non-operative (%) 58Male (%) 55.8Female (%) 44.2Age (y) (mean) 58.9Age (y) (range) 0 - 100Mean length of ICU stay (d) 4.98Median length of ICU stay (d) 2Range of ICU Stay (d) 0-395ICU mortality (in 25 units) (%) 22.9Hospital Mortality (in 25 units) (%) 31.6


Figure 9. Proportion of patients ventilated on the first ACP day during 2001.

0

10

20

30

40

50

60

70

80

90

100F

DR

I*^

VO

L*^

HM

*^

Wis

haw

*^

PR

I*

BG

H*

DG

RI*

QM

H*

St.

J*

SR

I*

VH

K*

CH

*

Ayr

*

RA

H*

RIE

VIG

AR

I

MK

*

IRH

*

WIG

SG

H

WG

H

NW

GR

I

SH

Unit

%

Mean (66.6%)


Figure 10. Proportion of patients ventilated at any time during 2001.

0

10

20

30

40

50

60

70

80

90

100F

DR

I*^

VO

L*^

HM

*^

Wis

haw

*^

PR

I*

BG

H*

DG

RI*

QM

H*

VH

K*

St.

J*

SR

I*

CH

*

Ayr

*

RA

H*

MK

*

RIE

WIG

IRH

*

AR

I

VIG

SG

H

WG

H

NW

GR

I

SH

Unit

%

Mean (70.4%)


Figure 11. Proportion of patients ventilated at any time in teaching hospital ICUs. (Ninewells: no data 1999-2000).

0

20

40

60

80

100

RIE WIG ARI VIG SGH WGH NW GRI SH

Unit

%

1999 (Mean=88%) 2000 (Mean=85.1%) 2001 (Mean=86.8%)


Figure 12. Proportion of all ventilated patients who are ventilated on the first ACP day in 9 teaching hospitals: 2001.

0

20

40

60

80

100

VIG ARI SGH WGH NW RIE SH GRI WIG

Unit

%

Mean (95.3%)


Figure 13. Proportion of patients in the ICUs who are ventilated on these ACP days.

0

10

20

30

40

50

60

70

80

90

100

1 8 15 22 29 36 43 50 57 64 71 78

ACP Day

Ven

tila

ted

(%

)


Figure 14. Proportion of ACP days in which there is ventilatory support: 2001. Mean = 68% of ACP days.

0

10

20

30

40

50

60

70

80

90

100

FD

RI*

^

VO

L*^

HM

*^

Wis

haw

*^

PR

I*

CH

*

DG

RI*

BG

H*

QM

H*

St.

J*

SR

I*

VH

K*

WIG

Ayr

*

VIG

RA

H*

RIE

AR

I

IRH

*

SH

NW

SG

H

WG

H

MK

*

GR

I

Unit

%


Figure 15. Proportion of ACP days days in which there is ventilatory support alone, with either cardiovasular or renal support, or with both:

2001.

0

10

20

30

40

50

60

70

80

90

100

FD

RI*

^

VO

L*

^

HM

*^

Wis

haw

*^

PR

I*

CH

*

DG

RI*

QM

H*

SR

I*

VH

K*

St.

J*

BG

H*

Ay

r*

RA

H*

VIG

WIG

IRH

*

RIE

SH

SG

H

AR

I

NW

WG

H

MK

*

GR

I

Unit

AC

P D

ay

s (%

)

Renal or CVS onlyCardiovascular and renal support, but no ventilator supportVentilator support, but no cardiovascular or renal supportVentilator and renal support, but no cardiovascular supportVentilator and cardiovascular support, but no renal supportVentilator, renal and cardiovascular support


Figure 16. Provision of renal replacement therapy: 2001.

0

20

40

60

80

100

120

140

160

IRH

*

VO

L*

^

FD

RI*

^

Ay

r*

Wis

haw

*^

SR

I*

BG

H*

SH

RA

H*

SG

H

CH

*

VIG

St.

J*

DG

RI*

WG

H

HM

*^

QM

H*

MK

*

NW

GR

I

WIG

AR

I

RIE

Unit

N

0

5

10

15

20

25

%

Number of patients (N)Proportion of admissions (%)


Figure 17. Provision of renal replacement therapy in 2001. Proportion of patients in Scottish ICUs receiving RRT = 8.1%, utilising 8.5% of ACP days.

0

5

10

15

20

25

FD

RI*

^

Ayr

*

Wis

haw

*^

VO

L*^

IRH

*

SR

I*

BG

H*

SH

VIG

CH

*

HM

*^

RA

H*

WG

H

SG

H

DG

RI*

QM

H*

St.

J*

MK

*

NW

GR

I

AR

I

WIG

RIE

Unit

%

Proportion of admissions (%)

Proportion of days (%)


Figure 18. Proportion of patients receiving inotropes/vasopressors in Scottish ICUs: 2001.

0

10

20

30

40

50

60

70

FD

RI*

^

VO

L*^

Wis

haw

*^

QM

H*

Ayr

*

HM

*^

CH

*

RA

H*

VIG

VH

K*

St.

J*

SR

I*

PR

I*

BG

H*

MK

*

IRH

*

WIG

RIE SH

SG

H

DG

RI*

GR

I

AR

I

NW

WG

H

Unit

%

Mean (38.2% )


Figure 19. Proportion of patients with PAFC in situ on 1st day of ICU (mean = 6.7%) or at any time during ICU (mean = 10.9%): 2001.

0

10

20

30

IRH

*

VH

K*

CH

*

NW

VO

L*

^

QM

H*

FD

RI*

^

Ay

r*

VIG SH

Wis

haw

*^

SR

I*

MK

*

GR

I

St.

J*

HM

*^

WIG

PR

I*

RA

H*

DG

RI*

RIE

WG

H

SG

H

BG

H*

AR

I

Unit

%

Day 1 Any time


Figure 20. Trend over time of admission sources (N) to Scottish ICUs. Increased numbers in 2001 as all 26 adult, general ICUs participated

in 2001, unlike other years.

0

500

1000

1500

2000

2500

3000

3500

4000

Theatre Ward thishosp.

A&E HDU thishosp.

Wardotherhosp.

ICU otherhosp.

HDU otherhosp.

ICU thishosp.

Home

Source

N

1998 1999 2000 2001


Figure 21. Trend over time of admission sources (%) to Scottish ICUs. Gives better representation of variation in admissions sources,

incorporating all ICUs.

0

5

10

15

20

25

30

35

40

45

50

Theatre Ward thishosp.

A&E HDU thishosp.

Wardotherhosp.

ICU otherhosp.

HDU otherhosp.

ICU thishosp.

Home

Source

%

1998 1999 2000 2001


Figure 22. Variation in admissions to ICU from other hospitals.

0

300

600

900

1998 1999 2000 2001Year

N

0

2

4

6

8

10

12

%

Number

Proportion


Figure 23. Illness severity: Median APACHE II scores (inter-quartile range), 2001. Scottish median: 19 (interquartile range 14 & 25).

0

5

10

15

20

25

30

FD

RI*

^

QM

H*

PR

I*

IRH

*

St.

J*

SR

I*

DG

RI*

VH

K*

Wis

haw

*^

BG

H*

NW

CH

*

VIG

SG

H

HM

*^

MK

*

Ay

r*

RA

H*

VO

L*

^

WIG

RIE

WG

H

AR

I

GR

I

SH

Unit

Sco

re

APACHE score (Median & IQR)


Figure 24. Scottish overall SMRs (APACHE II model) in 25 units in 2001. Mean: 1.02, 0.995-1.05.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

A* B* C* D* E* F* G H I J* K* L* M* N* O* P* Q R* S T U* V* W X Y

Unit

SM

R

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

SM

R

unit SMR unit 95% CIunit 95% CI Scottish SMRScottish 95% CI Scottish 95% CI


Figure 25. In-hospital mortality of all admissions to Scottish ICUs, 2001.

0

5

10

15

20

25

30

35

40

45

A* B* C* D* E* F* G H I J* K* L* M* N* O* P* Q R* S T U* V* W X Y

ICU

%

Unit mortality (%), Mean=23% Hosp mortality (%), Mean=31.5%


Table 9. Summary demographic characteristics, 2001.

Patients withAPACHE prediction

Admissions (n) 6224Operative (%) 40Non-operative (%) 60Mean length of ICU stay (d) 5.7Median length of ICU stay (d) 2.3Range of ICU Stay (d) 0-395ICU mortality (%) 24Hospital Mortality (%) 33Ultimate Hospital Mortality (%) 35.2APACHE II Score (mean) 19.7APACHE II prediction (%) 34.4SMR (95% CIs) 1.02 (0.995-1.05)


Figure 26. Scottish SAPS overall SMRs in 25 units, 2001. Mean: 1.31, 1.28-1.35.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

G I E* D* N* B* A* H L* C* J* K* P* Y M* W V* U* O* T F* X R* Q S

Unit

SM

R

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

SM

R

unit SMR unit 95% CIunit 95% CI Scottish SMRScottish 95% CI Scottish 95% CI


Table 10. Variation in illness severity, length of ICU stay and admission APACHE system categories: 1998-2000.

APACHE IIAdmission APACHEDiagnostic SystemCategory

Proportion(%) of

patients

LOS(d)

meanScore

Probability(%)

Gastrointestinal (GI) 31 4.6 18.1 36.92Respiratory (Resp) 22 7.6 20.21 33.08Cardiovascular (CVS) 21 4.9 22.96 43.33Neurological (Neuro) 10 3.3 17.62 21.22Trauma 7 5.7 13.46 12.15General 5 2.2 15.13 21.09Renal 3 4.4 19.55 25.98Metabolic/endocrine(Metabolic)

1 3.4 19.50 24.40

Haematological (Haem) 0 3.8 22.33 50.21


Table 11. Variation in illness severity, length of ICU stay and admission APACHE system categories in all scored

patients: 2001.

APACHE IIAdmission APACHEDiagnostic SystemCategory

Number ofpatients

Proportion(%) of

patients

LOS(d)

meanScore

Probability(%)

Gastrointestinal (GI) 1709 27.5 5.3 18.62 38.72Respiratory (Resp) 1420 22.8 8.1 20.13 33.16Cardiovascular (CVS) 1302 20.9 5.4 23.74 46.71Neurological (Neuro) 756 12.1 4.2 18.79 25.75Trauma 453 7.3 6.8 14.28 13.62General 316 5.1 2.2 15.06 20.14Renal 153 2.5 4.3 20.59 28.78Metabolic/endocrine(Metabolic)

84 1.3 3.5 21.13 25.50

Haematological (Haem) 31 0.5 7.4 22.03 47.98


Figure 27. Scottish SMRs by APACHE system: 2001.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

GI Resp CVS Neuro Trauma General Renal Metabolic Haem

APACHE system

SM

R

unit SMR unit 95% CI unit 95% CI


Figure 28. Frequency distribution of prescribing Drotrecogin alfa (activated). N=96. October was an incomplete month.

0

2

4

6

8

10

12

14

16

Oct-02 Nov Dec Jan-03 Feb March April May June July

Month

N


Figure 29. Use of Drotrecogin alfa (activated) within NHS Boards, N=96 until 31st July.

0

5

10

15

20

25

30

35

A &

C

A &

A

Bor

ders

D &

G Fif

e

F V

Gra

mpi

an

GG

Hig

hlan

d

Lan

arks

hire

Lot

hian

Tay

side

NHS Board

N


Figure 30. Comparison between original and validated APACHE II score for recipients of Drotrecogin alfa (activated).

0

3

6

9

12

15

<15 15 - 19 20 -24 25 - 29 30 - 34 35 or >

APACHE II score

N

ORIGINAL VALIDATED


Figure 31. Annual expenditure on sedatives and NMBAs: 2001/02.

£0

£10,000

£20,000

£30,000

£40,000

£50,000

£60,000

£70,000

1 2 3 4 5 6 7 8Unit

Ex

pen

dit

ure

NMBAs

Sedatives/Analgesics


Figure 32. Sedatives and NMBAs as a percentage of ICU drug expenditure.

0

10

20

30

40

1 3 5 6 7 8Unit

%


Figure 33. Ratio of expenditure of NMBAs:Sedatives.

0

10

20

30

40

50

60

1 2 3 4 5 6 7 8Unit

%


Figure 34. Sedative costs per day.

0

10

20

30

40

50

60

1 2 3 4 5 6 7 8

Unit

%

Sedative cost/ Total Day

Sedative cost/ Ventilated day

scottish intensive care society audit group, annual report 2003. note from scottish intensive care...

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