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Gjörgæsla í 30 ár : þróun innlagna og árangur starfseminnar á Borgarspítala / Sjúkrahúsi Reykjavíkur

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Authors
Kristinn Sigvaldason
Þórhallur Agústsson
Ólafur Þ. Jónsson
Issue Date
2000-11-01

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Thirty years of intensive care. Clinical experience at Reykjavik Hospital
Citation
Læknablaðið 2000, 86(11):749-53
Abstract
Objective: Reykjavik Hospital has been the main trauma center in Iceland. The Intensive Care Unit (ICU) was founded in 1970 and has been in operation since then. The aim of this study was to review its clinical experience these 30 years. Material and methods: A retrospective study of patient records was conducted for all admissions to the ICU between 1970 and the end of 1999. Data was collected pertaining to the annual rate of admission, proportion of patients requiring ventilator treatment, mortality rate, age distribution, reasons for admission and medical speciality. Results: A total of 13,154 patients were admitted to the ICU between 1970 and the end of 1999. A steady increase in the rate of admissions was observed during the study period, reaching 550-600 patients for the ICU annually. There was a statistically significant increase in the proportion of patients requiring ventilator treatment over the study period, reaching 38% of ICU admissions by the end of the study. During the study period only one statistically significant change was observed in age distribution. The annual rate of admission to the ICU for patients over 60 years of age increased significantly between the periods 1985-1989 and 1990-1999. The proportion of surgical patients increased (70% of patients by the end of the study) and the proportion of medical patients decreased (ending at 30% of patients). During the last decade a significant increase was seen in patients admitted after major surgery. The observed mortality rate in the final years of the study was observed to be significantly less than it had been in previous years. The observed mortality rate from 1970 to 1989 was 11.7% of patients, decreasing to 8.6% from 1990 to 1998. The average length of stay was also observed to decline. Conclusions: The decline in mortality occurred in spite of an increased rate of admission and an increased workload. This change is attributed to improvement in the care of critically ill patients over the study period.
Gjörgæsludeild Borgarspítalans/Sjúkrahúss Reykjavíkur hefur nú starfað samfellt í þrjá áratugi. Deildin stendur nú á tímamótum þar sem hún á 30 ára afmæli og var ákveðið að stækka hana, auka rými fyrir sjúklinga, endurnýja tækjakost og bæta aðstöðu starfsfólks. Þykir því við hæfi að gera uppgjör á starfseminni til þessa. Tilgangur: Markmiðið var að kanna hvernig fjöldi innlagna, aldursdreifing sjúklinga, deildaskipting og dánarhlutfall hefur þróast frá opnun deildarinnar og hvort samsetning sjúklingahópsins hafi breyst á einhvern hátt. Efniviður og aðferðir: Upplýsingum var safnað úr dagbókum og tölvuskrá gjörgæsludeildar, ársskýrslum sjúkrahússins og frá sjúklingabókhaldi. Árlegur fjöldi innlagna, aldursdreifing, ástæða innlagnar, fjöldi sjúklinga í öndunarvél, deildaskipting og dánarhlutfall var skráð og starfstímanum skipt upp í fimm ára tímabil sem borin voru saman. Niðurstöður: Samtals voru 13.154 sjúklingar innritaðir á gjörgæsludeild. Innlögnum fjölgaði stöðugt á tímabilinu eða um 78% frá byrjun til enda og hlutfall þeirra sem þurftu meðferð í öndunarvél jókst jafnt og þétt en það bendir til vaxandi fjölda sjúklinga sem eru mikið slasaðir eða alvarlega veikir. Aldursdreifing hélst nánast óbreytt allt tímabilið en þó sést aukning á sjúklingum sem eru eldri en 60 ára. Fjölgun var á innlögnum frá skurðlækningasviði sjúkrahússins í samanburði við lyflækningasvið. Síðasta áratuginn sást marktækt lægra dánarhlutfall og styttri meðallegutími. Umræða: Fjölgun innlagna má skýra að hluta með vaxandi fólksfjölda en einnig með samruna Landakotsspítala og Borgarspítala. Innlögnum hefur þó fjölgað meira en sem nemur mannfjöldaþróun og þar vegur mest fjölgun innlagna eftir meiriháttar skurðaðgerðir. Ályktanir: Árangur starfseminnar virðist góður þar sem dánarhlutfall hefur lækkað og meðallegutími styst þrátt fyrir aukinn fjölda mikið veikra sjúklinga og hækkandi aldur þeirra. Framfarir í læknisfræði og hjúkrun virðast því skila sér í markvissari meðferð og bættum horfum sjúklinga með lífshættulega sjúkdóma eða alvarlega áverka.
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