scholarly journals Overdose admissions to a district general hospital intensive care unit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S95-S95
Author(s):  
Aoife Nechowska ◽  
Theophilus Samuels ◽  
Sameer Ranjan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Generation X ◽  
Age Groups ◽  
District General Hospital ◽  
Patient Records ◽  
Admission Data ◽  
Self Harm ◽  
The Mean

AimsThis audit aimed to analyse the patient population coming into East Surrey Hospital's Intensive Care Unit from 1993 to 2019.BackgroundThe Office for National Statistics (ONS) published a report in August 2019 on ages most likely to die by suicide and drug poisoning. Their data showed that Generation X were dying by this method in greater numbers than other age groups. This is in contrast with data from 1990s for England and Wales which showed people in their 20s were most likely to die by suicide or poisoning. This audit set out to look at admission data from an intensive care unit (ICU) in a district general hospital in Surrey over a similar period of time.MethodPatient records from 1993 to September 2019 were accessed using the WardWatcher database. To access the maxim number of admissions qualifying under the aims, the database was accessed by searching under “admission comments” for: overdose, self-harm, poison, suicide. These reports were downloaded and the lists were checked against each other to delete duplicates. This gave a total of 331 patients. The data were analysed by year, according to age, gender, season, psychiatric diagnoses and previous overdose attempts. Their outcomes were checked against recorded deaths. There was not enough information to investigate method of overdose.ResultA total of 331 patient records were accessed. The youngest patient was 15 years old, the oldest was 84 years old. The age dataset was non-parametrically distributed with the median age of 43 years (IQR 33-51 years). The age distributions for each year appeared symmetrical but total numbers for each year were small. The population was split as 191 female (58%) and 141 male (42%). 16 patients died on the ICU on admission with an overdose, 5% of total numbers, of which 19% had a previous overdose attempts and 44% had a psychiatric diagnosis. The youngest death was 22 and the oldest was 81 years old. The average age was 47 years, with the spread consistent in the 2000s and 2010s.ConclusionThe results from East Surrey Hospital's ICU do not reflect the analysis from the ONS. The mean age for each year has remained similar. Numbers for the audit were small and admission criteria to the ICU prescribe that the patient be critically unwell and may not be indicative of the total admissions to a district general hospital.

scholarly journals Cohort profile: Preliminary experience of 500 COVID-19 postive cases at a South West London District General Hospital

2020 ◽  
Author(s):  
R.E Field ◽  
I. Afzal ◽  
J. Dixon ◽  
V.R Patel ◽  
P Sarkar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Demographic Data ◽  
Cohort Analysis ◽  
District General Hospital ◽  
Ventilator Support ◽  
South West ◽  
Number Of Patients ◽  
The Mean

AbstractThis retrospective cohort analysis, reports the demographic data and early outcome of the first 500 patients who were admitted to a District General Hospital in South West London, UK and tested positive to COVID-19. The patients were admitted between 10 January and 10 April 2020; with the first COVID-19 positive diagnosis on 6 March. A surge in admissions started around the 15 March and peaked at the beginning of April.56.8% of the admissions were male and 43.2% were female. The average age of the 500 admissions was 69.32 years (SD 19.23 years, range 1 week to 99.21 years). By the morning of 14 April 2020, 199 patients had been discharged (Female 89, Male 111), 163 patients had died (female 61, male 102) and 131 remained as in-patients (female 66, male 71).Fewer than one in twenty deaths occurred in patients below the age of 50 years, in either gender. Mortality rose dramatically, for both genders, after the age of sixty with males being almost twice as vulnerable to dying, as females, during the 7th decade. Males older than their mid-fifties were more likely to die than leave hospital. The same applied to females beyond their mid seventies. We did not see any evidence of a poorer outcome associated with a lower decile for Index of Multiple Deprivation or convincing evidence that any Ethnic minority groups were more likely to die than the White subgroups. When compared to the equivalent medical conditions, normally treated in the early spring, COVID-19 has an increased mortality, adversely affecting more men and an older population.The mean duration from admission to discharge was 11.29 days (SD 11.50 days). For admission to death, the mean interval was 11.72 days (SD 11.05 days). 62 of the 500 admissions required ventilator support. Of this subgroup, 71% were male and 29% were female. By the morning of the 14 April, no female over the age of 60 had left the intensive care unit alive and no male over the age of 50 had left the intensive care unit alive. At this time-point, 1.2% of the 500 admitted patients had returned alive from the intensive care units, following a period of ventilator support. This figure will rise if prolonged ventilator and renal support proves effective.While only providing a snapshot of a relatively small number of patients, reviewed over a short time period, from a small geographic area, the data supports the view that the younger members of society are less vulnerable to the adverse sequelae of COVID-19 infection and that any return to normal work and social activities should be considered initially for the individuals who are less than 40-50 years of age. There is an ongoing need for analyses on larger patient cohorts using both demographic and detailed clinical data.

Coronary Care in a General Hospital

1971 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Gavin Shaw ◽  
Bernard Groden ◽  
Evelyn Hastings
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
First Year ◽  
Duration Of Stay ◽  
Before And After ◽  
The Mean ◽  
Coronary Care ◽  
Made In

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.

scholarly journals Etomidate in the management of severe Cushing’s disease and MRSA bacteraemia in a district general hospital in the United Kingdom

2019 ◽  
Vol 2019 ◽  
Author(s):  
Stephanie Wei Ping Wong ◽  
Yew Wen Yap ◽  
Ram Prakash Narayanan ◽  
Mohammad Al-Jubouri ◽  
Ashley Grossman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Cushing’S Disease ◽  
District General Hospital ◽  
Serum Cortisol ◽  
Cushing's Disease ◽  
High Morbidity ◽  
List Type ◽  
Cortisol Levels

Summary We report our experience on managing a case of florid Cushing’s disease with Methicillin-resistant Staphylococcus aureus (MRSA) sepsis using intravenous etomidate in the intensive care unit of a UK district general hospital. Learning points: Severe Cushing’s syndrome is associated with high morbidity and mortality. Etomidate is a safe and effective medical therapy to rapidly lower cortisol levels even in the context of severe sepsis and immunosuppression. Etomidate should ideally be administered in an intensive care unit but is still feasible in a district general hospital. During treatment with etomidate, accumulation of serum 11β-deoxycortisol (11DOC) levels can cross-react with laboratory cortisol measurement leading to falsely elevated serum cortisol levels. For this reason, serum cortisol measurement using a mass spectrometry assay should ideally be used to guide etomidate prescription.

Psychiatric intensive care after two years

1989 ◽  
Vol 13 (8) ◽  
pp. 421-422 ◽  
Author(s):  
J. M. O'Dwyer ◽  
B. S. Mann
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Mentally Ill ◽  
Psychiatric Patients ◽  
District General Hospital ◽  
Descriptive Study ◽  
Psychiatric Unit ◽  
Health Authorities

The following is a descriptive study of Willoughby Ward, a psychiatric intensive care unit, opened in Parkside Hospital, Macclesfield, in July 1986. It provides a moderately secure facility for the treatment of psychiatric patients within both Crewe and Macclesfield Health Authorities. The unit has 15 beds, of which two are funded and used by Crewe area, where, unlike Macclesfield, the psychiatric unit is located in the district general hospital. Managed as a locked ward, the patients are admitted under the provisions of the Mental Health Act 1983. As well as being mentally ill as defined in the Act, the patients were disturbed to a degree as to be unmanageable in open conditions.

scholarly journals Trends in the Severity of Self-Poisoning

1986 ◽  
Vol 79 (2) ◽  
pp. 74-75 ◽  
Author(s):  
J J A McAleer ◽  
G J J Murphy ◽  
R H Taylor ◽  
J L C Moran ◽  
F A O'Connor
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
District General Hospital ◽  
Drug Availability ◽  
Icu Admission ◽  
The Impact ◽  
Icu Treatment

Of 2947 patients admitted to a district general hospital over an 11-year period for the management of self-poisoning, 148 (5%) required intensive care unit (ICU) treatment. There was a significant increase in the number of self-poisonings admitted each year, whereas the number requiring ICU admission did not change. Therefore the proportion of patients requiring ICU admission fell significantly over the study period ( P< 0.0005). Of 898 patients admitted from 1973 to 1977, 62 (6.9%) were treated in ICU. Of 2049 patients admitted from 1978 to 1983, 86 (4.2%) required ICU treatment. It is felt that this trend is explained by a rise in parasuicidal self-poisonings. The impact of change in drug availability is evident in the significant reduction in ingestion of sedative barbiturates.

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