Department of Internal Medicine Medical Intensive Care Unit

Department of Internal Medicine

Medical Intensive Care Unit (MICU) MICU 68% CCU 32%

Intensivists Full time intensivists in MICU since 1 April 2005 l Semi-close MICU unit l Staff ward l Initiated ICU organization l

Intensivist and MICU organization l Full - time intensivists Ward round Triage, discharge Teaching and training medical residents

Intensivist and MICU organization l MICU - protocol/guideline Drug preparation/infusion guideline Feeding Sedation and analgesia Insulin protocol Intra-hospital transport guideline

ICU audit

ICU performance measurement Outcome -> mortality (ICU, hospital) -> length of stay l Access of care l Complication rate l… l Outcome -> Mortality Standard Mortality Ratio (SMR)

ICU performance l Severity score and organ dysfunction score in ICU of Songklanagarind hospital l Prospective observational cohort study l Inclusion criteria Patients > 15 yrs who admitted at ICU during July 2004 - Aug 2008 § Exclusion criteria - ICU LOS < 4 hrs - Re-admission

ICU performance: Intensivists Exclude ACS and rhythm disturbance patients (likely CCU patients) l Acute Physiology and Chronic Health Evaluation II (APACHE II) l Simplified Acute Physiology Score II (SAPS II) l

Standard Mortality Ratio (SMR) - Standard mortality ratio (SMR)= observe/predict mortality SMR < 1 good ICU performance - International ICU comparison Comparison of hospital - ICU evaluation -

Aug

Aug

Mortality Aug

SMR by APACHE II 0. 95 (0. 90 -0. 99) Mayo Clinic (Mayo Clin Proc 2005) 0. 93 (0. 84 -1. 02) England (ICM 2003) - Aug

SMR by SAPS II 1. 12 (0. 92 -1. 32) Austria (ICM 2000) 0. 92 (0. 83 -1. 01) England (ICM 2003) 0. 84 (0. 82 -0. 85) French (2006) Aug

Conclusion Intensivists could improved ICU organization and performance l Further assess in other ICU performance - LOS, adjust LOS ratio - delay admission, ER waiting times - readmissions, infection control. l