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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.
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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%)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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%)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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%)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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%)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
(%
)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
%
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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 (%)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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 (%)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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% )
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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%
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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)
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
Figure 32. Sedatives and NMBAs as a percentage of ICU drug expenditure.
0
10
20
30
40
1 3 5 6 7 8Unit
%
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
Figure 33. Ratio of expenditure of NMBAs:Sedatives.
0
10
20
30
40
50
60
1 2 3 4 5 6 7 8Unit
%
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
Figure 33. Ratio of expenditure of NMBAs:Sedatives.
0
10
20
30
40
50
60
1 2 3 4 5 6 7 8Unit
%
Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk
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