1. Audit of the Patients Admitted in Critical Care Units of BPKIHS
Mehta*1 RS, Karki*2 P, Bhattari*3 BK, Rai*4 I, Shrestha*5 L.
B.P. Koirala Institute of Health Sciences, Nepal
Email: ramsharanmehta@hotmail.com
Abstract:
Introduction: Most hospitalized patients with critical conditions are cared for in critical care
unit patient care areas designed to provide extraordinary treatment by specially trained healthcare
professionals, often with the use of high-tech equipment. B.P. Koirala Institute of Health
Sciences has a 700 bedded tertiary care center hospital with 8 beds ICU and 6 beds CCU with
modern facilities.
Objectives: The objective of this study was to find out the demographic characteristics and the
diseases pattern of the admitted patients in Intensive Care Unit and Coronary Care Unit (ICU &
CCU) of BP Koirala Institute of Health Sciences.
Methodology: It was a hospital based retrospective descriptive study design, conducted among
the admitted patients of ICU and CCU from 14th April 2009 to 13th March 2010 (2066 BS). The
total number of patients admitted in critical care units during the study period constituted the
population of the study. Systemic random sampling technique was used to collect the data using
the prepared Performa from the admission register of the ward. The data was collected from the
admission register from 1-7-2010 to 7-7-2010. Total 120 patients were included in the study out
of total admitted 601 patients using stratified systemic random sampling technique.
Results: During the study period in ICU total 269 patients were admitted, 91 transferred out, 63
referred, 61 expired, 37 left against medical advice (LAMA), and 17 was still on bed; similarly
in CCU total 346 patients were admitted, 211 were transferred out, 19 discharged, 55 referred, 38
expired and 30 LAMA. Most of the patients admitted were of age 20-60 years, from Sunsari
(42.1%), Morang (18.2%), and Jhapa (14.9%) district, with mean duration of stay 7.47 days and
male, female ratio is nearly equal. The major diagnosis for ICU admission was complication of
exploratory laboratory (11.5%), OPP (11.5%), encephalitis (7.7%), and multi-organ failure
(5.8%), similarly the major diagnosis for CCU admission was acute coronary syndrome (21.7%),
myocardial infraction (MI) (18.8%), Shock (8.7%), and RHD (7.2%).
Conclusions: The number of admission in ICU/CCU is increasing as the bed strength, patients
load and complexity of cases increasing; hence the necessary management in ICU/CCU is
mandatory to overcome the future problems. The diagnosis of patients admitted in the unit is
complicated and prognosis is also not very satisfactory, hence exploratory study is essential.
Key Words: Demographic Profile, Outcomes, Critical Care
Authors: *1 Ram Sharan Mehta, Associate Professor, Medical-Surgical Nursing Department, *2 Prof. Prahlad
Karki, HOD, Department of Internal Medicine, *3Prof. Dr. Balkrishna Bhattari, Dept. of Anesthsiology and
Critical Care, *4Ms. Indira Rai, Nursing In-charage, ICU/CCU unit, *5Ms Laxmi Shrestha, ICU Nurse.
1

2. Introduction: An intensive care unit (ICU) is a specialized section of a hospital that provides
comprehensive and continuous care for persons who are critically ill and who can benefit from treatment.
The purpose of the intensive care unit is simple even though the practice is complex. Healthcare
professionals who work in the ICU or rotate through it during their training provide around the clock,
intensive monitoring and treatment of patients seven days a week. 1
Patients cared for in ICUs include those with severe trauma, major head injury or coma, respiratory and/or
hemodynamic insufficiency, or failure of one or more organ systems and those with intensive monitoring
needs following major surgery. The medical needs of ICU patients are often complex, requiring of
caregivers, who work under stressful conditions, a high degree of knowledge and skill. Despite the
dedication and competency of ICU caregivers, mortality rates for critical care patients remain high,
ranging from 10% to 20%.2 The intensive visit will provide treatment management, diagnosis,
interventions, and individualized care for each patient recovering from severe illness. 3
Despite tremendous resource utilization, the majority of trauma patients with prolonged ICU stays can
eventually return to varying degrees of functional daily living and independence, but not to preinjury
levels. A subgroup of severely injured elderly patients had a significantly higher mortality rate. However,
elderly survivors that entered our rehabilitation facility fared as well as the younger patients.1
The main feature of coronary care is the availability of telemetry or the continuous monitoring of the
cardiac rhythm by electrocardiography. This allows early intervention with medication, cardioversion or
defibrillation, improving the prognosis. As arrhythmias are relatively common in this group, patients with
myocardial infarction or unstable angina are routinely admitted to the coronary care unit.4 Early success
in CCUs with resuscitation and with the detection and treatment of arrhythmias focused researchers'
attention on left ventricular failure and cardiogenic shock. The Swan-Ganz flow-guided catheter was
introduced, and its use for invasive monitoring of cardiac hemodynamic became routine in some centers. 5
In hospital critical care units, many of the individual challenges confronting other hospital units intersect,
making the critical care setting the most complex environment in the healthcare facility. Nursing care has
an important role in a critical care unit. The nurse's role usually includes clinical assessment, diagnosis,
and an individualized plan of expected treatment outcomes for each patient i.e. implementation of
treatment and patient evaluation of results.
Objectives: The objective of this study was to find out the demographic characteristics and the diseases
pattern of the admitted patients in Intensive Care Unit and Coronary Care Unit (ICU and CCU) of BP
Koirala Institute of Health Sciences. , Dharan, Sunsari, Nepal.
Methodology: It was a hospital based retrospective descriptive study design, conducted among the
admitted patients in CCU and ICU of BPKIHS using the admission register of the ward. A Performa was
prepared and the required informations were collected in the Performa form the admission register. The
total number of patients admitted in critical care units during the study period constituted the population
of the study. Stratified simple random sampling technique was used to collect the data using the prepared
Performa from the admission register of the ward. The data was collected from the admission register
from 1-7-2010 to 7-7-2010. Total 120 patients were included in the study out of total admitted 601
patients using stratified systemic random sampling technique. The collected data was entered in Excel and
analyzed using SPSS-11.5 software package. The details of the findings are depicted in the tables and
graphs.
Results: During the study period, in ICU total 269 patients were admitted, 91 transferred out, 63
referred, 61 expired, 37 LAMA, and 17 was still on bed; similarly in CCU total 346 patients were
2

3. admitted, 211 were transferred out, 19 discharged, 55 referred, 38 expired and 30 LAMA. Most of the
patients admitted were of age 20-60 years, from Sunsari (42.1%), Morang (18.2%), and Jhapa (14.9%)
district, with mean duration of stay 7.47 days and male, female ratio is nearly equal. The major diagnosis
for ICU admission is complication of exploratory laboratory (11.5%), organophosphorus poisoning (OPP)
(11.5%), encephalitis (7.7%), and multi-organ failure (5.8%), similarly the major diagnosis for CCU
admission is acute coronary syndrome (21.7%), MI (18.8%), Shock (8.7%), and RHD (7.2%). The details
are depicted in table 1 to 6.
Discussion: Critical care unit is specialized unit in which expert medical, nursing and technical staffs
were provided care with equipment for monitoring and immediate life saving intervention involved in
paralleled with advance invasive surgical, medical procedures. Principles of Critical Care are: Early
diagnosis and identification of problems, Anticipation of possible events and complication, a holistic
approach to critical illness, the considered use of technology and Recognition of the limit of critical care.
Out of total 269 ICU admissions during the study period of one year, 63 patients were reported, 61
expired, 37 LAMA requires the detailed investigation to explore the reasons for poor outcome. Similar
findings were reported by Yaseen6, Rosenberg7 and Weissman8.
In CCU total 346 patients were admitted during the same period and among that 55 patients were referred,
38 expired and 30 LAMA, require the detailed investigations to explore the reasons for poor outcome.
Similar findings were reported by Praveen9 and Kanus10.
Conclusions: The number of admission in ICU/CCU is increasing as the bed strength, patients load and
complexity of cases increasing; hence the necessary management in ICU/CCU is mandatory to overcome
the future problems. The diagnosis of patients admitted in the unit is complicated and prognosis is also
not very satisfactory, hence exploratory study is essential.
Reference:
1. Miller RS, Patton M, Graham RM, Hollins D. Outcomes of trauma patients who survive
prolonged lengths of stay in the intensive care unit. J Trauma. 2000; 48(2):229-34.
2. Weissman C. Analyzing intensive care unit length of stay data: problems and possible solutions.
Crit Care Med. 1997; 25: 1594–1600.
3. Rosenberg AL, Hofer TP, Hayward RA et al. Who bounces back? Physiologic and other
predictors of intensive care unit readmission. Crit Care Med. 2001; 29: 511–518.
4. Mehta NJ, Khan IA. Cardiology's 10 greatest discoveries of the 20th century. Texas Heart
Institute J. 2002; 29:164-71.
5. Julian DG. The history of coronary care units. British Heart J. 1987; 57:497–502.
6. Yaseen A, Venkatesh S, Samir H, Abdullah Al S, Salim Al M. A Prospective Study Of Prolonged
Stay In The Intensive Care Unit: Predictors And Impact On Resource Utilization. International
Journal For Quality In Health Care, 2002, 14:403-410
7. Rosenberg AL, Hofer TP, Hayward RA et al. Who bounces back? Physiologic and other
predictors of intensive care unit readmission. Crit Care Med. 2001; 29: 511–518.
8. Weissman C. Analyzing intensive care unit length of stay data: problems and possible solutions.
Crit Care Med. 1997; 25: 1594–1600.
9. Praveen K, Devajit S, Reeta S et al. Demographic Profile and outcome analysis of a tertiary level
pediatric intensive care unit. 2004; 71(7): 587-591.
10. Kanus WA, Draper EA, Wagner DP et al. Compression of Frequency distribution in
demonstration unit and 13 tertiary hospitals. Crit Care Med. 1985; 13: 823.
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4. Table 1
Demographic Characteristics of the Subjects
Responses
Total
ICU CCU
SN Demographic Characteristics (ICU & CCU)
(n=52) (n=69)
(n=121)
Percentage (%) Percentage (%) Percentage (%)
1 Age Group
< 20 11.5 5.8 8.3
20-40 40.4 20.3 28.9
40-60 28.9 22.1 35.5
>60 19.2 33.3 27.5
Mean 41.44 52.35 47.66
SD 19.429 19.305 20.025
Range 15-80 15-84 15-84
2 Gender
a. Male 50 62.3 57
b. Female 50 37.7 43
3 Caste of the subject
a. Brahmin/Chhetry 17.3 24.6 21.5
b. Mangolian (Rai, Limbu, Gurung, 26.9 29 28.1
Magar, Tamang)
c. Newar 9.6 13 11.6
d. Trai Origin Caste 46.2 33.4 38.3
Table 2
Duration of stay of the subjects
Responses
Total
ICU CCU
SN Duration of Stay (ICU & CCU)
(n=52) (n=69)
(n=121)
Percentage (%) Percentage (%) Percentage (%)
1 1-3 days 50 39.1 43.8
2 4-7 days 11.5 39.2 27.3
3 8-14 days 15.4 16 15.1
4 >14 days 23.1 5.7 13.2
Mean 8.96 6.83 7.74
SD 9.856 11.438 10.795
Range 1-43 1-89 1-89
Table 3
Major Diagnosis of the subjects
SN Diagnosis of the subject Number (%)
Diagnosis of ICU admitted Patients (n=52)
1 Exploratory Laprotomy: complications 6(11.5)
2 Organ-phosphorus Poisoning 6(11.5)
3 Encephalitis 4(7.7)
4 Multi-organ Failure 3(5.8)
5 Cholecystectomy 3(5.8)
6 Stab-injury 3(5.8)
7 Others 27(52)
Diagnosis of ICU admitted Patients (n=69)
1 Acute Coronary Syndrome (ACS) 15(21.7)
2 Myocardial Infraction (MI) 13(18.8)
3 Shock 6(8.7)
4 Rheumatic Heart Disease (RHD) 5(7.2)
5 Diabetic Kito-acidosis (DK) 4(5.8)
6 End Stage Renal Disease (ESRD) 3(4.3)
7 Others 23(33)
4