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Epidemiology of admissions to 11 stand-alone high-dependency care units in the UK

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Abstract

Purpose

High-dependency care units (HDUs) are a focus of research to optimize critical care resource allocation. HDUs provide a level of care between the general ward and the intensive care unit (ICU). However, few data report on the case mix and outcomes of patients in these units.

Methods

Retrospective observational cohort study of patients admitted to 11 stand-alone HDUs in the UK from 2008 to 2011. We stratified patients by location prior to HDU admission and location on discharge from HDU, and we summarized the case mix, transitions of care, and mortality.

Results

Of 9008 patients admitted to 11 stand-alone HDUs, 56.5 % were male and the mean age was 62.7 ± 17.9 years. The majority of patients admitted to HDUs were non-surgical (59.3 %), with 22.4 and 20.1 % admitted from the ICU and general ward, respectively; 41.3 % were admitted from the operating room or recovery suite. The median length of stay in HDU was 1.8 days (IQR 0.9–3.5) and in-HDU mortality was 5.1 %. Among HDU survivors (n = 8551), 8.5 % were discharged to an ICU, 80.9 % to a general ward, and 10.6 % to other care areas. For patients admitted to HDU from an ICU, only 5.8 % were readmitted to ICU. Hospital mortality for the HDU population was 14.8 %; for patients discharged to an ICU, hospital mortality was 43.6 %.

Conclusions

In a sample of 11 stand-alone HDUs in the UK, patients are from many different hospital locations. Hospital mortality for patients requiring HDU care is high, particularly for patients who require transfer to an ICU.

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Acknowledgments

We would like to thank the Case Mix Programme staff at Intensive Care National Audit and Research Centre (ICNARC) for the use of these data.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Columbia University, New York, NY, USA

    Meghan Prin & Hannah Wunsch

  2. Intensive Care National Audit and Research Centre, London, UK

    David Harrison & Kathryn Rowan

  3. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Avenue, Room D1.08, Toronto, ON, M4N 3M5, Canada

    Hannah Wunsch

  4. Department of Anesthesiology, University of Toronto, Toronto, ON, Canada

    Hannah Wunsch

Authors
  1. Meghan Prin
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  2. David Harrison
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  3. Kathryn Rowan
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  4. Hannah Wunsch
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Corresponding author

Correspondence to Hannah Wunsch.

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Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Funding

Award Number K08AG038477 from the National Institute on Aging to Hannah Wunsch.

Additional information

Take-home message: In a sample of 11 HDUs in the UK, there was a mix of patients from many different hospital locations, with the majority being non-surgical. Hospital mortality for patients requiring HDU care was high, particularly for patients who required transfer to an ICU.

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Prin, M., Harrison, D., Rowan, K. et al. Epidemiology of admissions to 11 stand-alone high-dependency care units in the UK. Intensive Care Med 41, 1903–1910 (2015). https://doi.org/10.1007/s00134-015-4011-y

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  • DOI: https://doi.org/10.1007/s00134-015-4011-y

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