• S Hariharan, H S L Moseley, and A Y Kumar.
• Department of Anaesthesia and Surgical Intensive Care, Queen Elizabeth Hospital, Barbados, West Indies. hseetharaman@fms.uwi.tt
• W Indian Med J. 2006 Jan 1;55(1):25-9.

ObjectiveTo evaluate the clinical characteristics and costs incurred for patients who stayed for a prolonged period in a surgical intensive care unit (ICU).Design And MethodsData of all patients admitted to a surgical ICU in Barbados during the period of two years from July 1999 to June 2001 were prospectively collected. Demographic data, diagnoses on admission and Acute Physiology and Chronic Health Evaluation (APACHE II) score were recorded. Costs for treatment were calculated from using a cost block model. The characteristics of patients who had a prolonged stay (> 14 days) were compared with a concurrent cohort of patients who stayed less than 14 days.ResultsOf 438 admissions, 58 (13.2%) stayed in the ICU for more than two weeks. The overall age, hospital outcome, APACHE II scores in the prolonged stay group were significantly higher than that of the patients who stayed less than two weeks. Cost analysis showed about six times more expenditure in the long stay patients (dollar US 3800 vs dollar US 24000). Of the prolonged stay ICU patients, 29.2% would have required only a step-down unit due to less severity of illness as evidenced by their low mean APACHE II scores [7.3 +/- 2.6 (SD)] compared to overall mean APACHE II score 10.7 +/- 7.5 (SD).ConclusionThe study highlighted the need for a step-down unit and a protocol to transfer eligible patients to such a unit.

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