A Ten-Year Review of the Management of Medical Patients in the Intensive Care Unit in a Resource-Poor Setting in Southern Nigeria

Abstract

Purpose: The Intensive Care Unit (ICU) is a specialist ward within a hospital, with a concentration of expertise and resources for the management of critically ill patients. Some clinicians think of the ICU only in relation to surgical practice, maybe because many intensivists are anaesthesiologists and anaesthesia is closely linked to surgery. However, this notion may not be entirely true. This study aims to highlight the importance of the ICU to patients with medical challenges. Methodology: This is a ten-year retrospective study conducted at the University of Port Harcourt Teaching Hospital. Ethical approval for the study was sought and gotten from the hospital’s ethical committee. All patients who were admitted into the ICU with medical diagnosis were included in this study. The information gotten includes history, age, sex, diagnosis, length of admission, and outcome. The data collected was analyzed and presented in tables and charts. Findings: The mean age was 51.41±20.12. The highest age was 95 years. The mean bill paid was 80,718.55 Naira and the largest bill paid was 605,500 Naira while the least bill paid was 2000. The mean duration of stay was 6.59 days and ranged from a day to 120 days. The males were 268 (51.8%) while the females were 249(48.2%). Two hundred and sixty-five patients (51.3%) died during the study period. Patients who were transferred out of the ICU spent the highest amount of money and spent the most time (10.19 days) in the ICU. The patient who died spent the least amount of time (4.56 days) in the ICU. A hundred and two patients were discharged from the ICU. Transferring them to a high dependency unit or ward will save cost. As the age increased, the comorbidities also increased with 309 out of 517 having comorbidities. Exacerbation of comorbidity led to admission in the ICU. Recommendation: Medical patients admitted into the ICU tend to have a higher mean age and have a higher mortality rate. Older patients tend to have more comorbidity. Proper and effective management of the ICU will save cost. Proper management of comorbidities in older patients can lead to an improvement in health. Patients who are fit, could be transferred to other wards and discharged from there, this will free up beds in the ICU, increase effective use of the ICU and save cost.