Biomedical subjects

D E Lawrence

Publications and source records attributed to D E Lawrence.

3 recordsLinked to original sources

PubMed1981

The range of intensive care services today.

During the past 20 years, there has been a large increase in the number of hospitals with intensive care units (ICUs). To discover what services are provided to the growing number of ICU patients, we studied 624 consecutive admissions to a general surgical-medical ICU within a university hospital. We recorded the proportion of admissions and services involving intensive treatment as opposed to concentrated nursing care or monitoring. We found that for nearly half (49%) of the admissions and during two thirds (65%) of the nursing shifts, the emphasis was on close nursing care and observation, not intensive treatment. Of 252 patients admitted for monitoring, 216 (86%) never required active treatment before discharge. The average length of stay of these 216 patients was 2.1 days. If this distribution of services and admissions within one university hospital is also found at other institutions, it suggests that a substantial portion of ICU services may now be directed at monitoring stable, noncritically ill patients.

Critical Care↗

PubMed1981

APACHE-acute physiology and chronic health evaluation: a physiologically based classification system.

Investigations describing the utilization pattern and documenting the value of intensive care are limited by the lack of a reliable and valid classification system. In this paper, the authors describe the development and initial validation of acute physiology and chronic health evaluation (APACHE), a physiologically based classification system for measuring severity of illness in groups of critically ill patients. APACHE uses information available in the medical record. In studies on 582 admissions to a university hospital ICU and 223 admissions to a community hospital ICU, APACHE was reliable in classifying ICU admissions. In validation studies involving these 805 admissions, the acute physiology score of APACHE demonstrated consistent agreement with subsequent therapeutic effort and mortality. This was true for a broad range of patient groups using a variety of sensitivity analyses. After successful completion of multi-institutional validation studies, the APACHE classification system could be used to control for case mix, compare outcomes, evaluate new therapies, and study the utilization of ICUs.

Critical Care↗

PubMed1981

Neurosurgical admissions to the intensive care unit: intensive monitoring versus intensive therapy.

Among 624 consecutive admissions to a medical-surgical intensive care unit (ICU), we identified 289 patients admitted for concentrated nursing care and intensive monitoring of whom only 44 (15%) received active treatment before discharge. Within this group were 82 patients admitted after uncomplicated elective neurosurgery. Only 1 of these patients required active treatment before discharge. None had any major physiological abnormality detected by electronic monitoring, and no patient required readmission to the ICU or died during hospitalization. These 82 neurosurgical admissions accounted for 13% of the total admissions over the study period and 10.5% of the total number of ICU days. The admission of these patients to the ICU was prompted by the need for labor-intensive services, such as hourly neurological checks, that were not available on the regular hospital floor. For stable postoperative neurosurgical patients, improved staffing of hospital wards could lead to a reduction in the number of admissions to the ICU.

Central Nervous System Diseases↗