Surely all ICUs are the same?
Posted on Wednesday 3rd October 2007
Not so!
You would imagine that the standard and quality of care would be the same in any intensive care in a given country. Perhaps more so amongst large units (i.e.: more than 10 beds) in the same city. Again unfortunately this is not the case. Due to variations in protocols, patient casemix, level of medical support, funding and bed pressures there can often be significant differences between results.
In the last 30 years or so Evidence-based Medicine has become the vogue. It works on the principle of validating treatments against outcomes rather than just assuming that current practice is optimal. Intensive care performance can be assessed by measuring patient mortality rates, in other words how many patients die. Obviously this measure alone doesn’t tell the whole story as specialist ICUs will receive far sicker patients than other ICUs so can be forgiven if more of their patients die.
So the solution is to calculate the Standardised Mortality Ratio. The data comes from calculating the patient’s risk of death based on their Acute Physiology and Chronic Health Evaluation score. This essentially says that if you took 100 identical patients, how many of them would be expected to die whilst on the unit. Over the whole year all the patients are scored and the overall figures compared with the “expected average”. This generates the Standardised Mortality Ratio (SMR) which is how many patients die on the unit versus how many are expected to die.
A good ratio is 1, in other words as many patients as are expected to survive/die do so. If the ratio is greater than 1 then more patients die than should do, and if the ratio is less than 1 then more patients survive than are expected to do so.
Anyway this preamble is designed to furnish the health consumer, i.e.: the patient (and their relatives) with an easy measure of whether the intensive care unit they are about to be admitted to is performing well or not. It is an entirely reasonable question to ask the doctors what their SMR is. If it’s 1 or less then all is well, however if it’s more than 1 then perhaps you’d be safer somewhere else!
Unfortunately mate, when you’ve just walked into someone’s boot, QMC have said no thanks, and you’re not doing that whole consciousness thing tremendously well, you’re kind of stuck with the ITU you end up in, unless you’re willing to take the risk of going with the most junior ITU trainee available along the back roads of wherever to a better place, who’s SMR may as a whole be better, but much to your later horror turns out to be deeply crap at head injuries.
If it’s a choice between the LRI and LGH I’d be happy to be in either rather than the morgue, so on that score I agree with you Alex.
If you have a head injury you are always going to be better off in a neuro unit and places like QMC should really drop their elitist mentality and take these patients.
I suppose my post was more aimed at shit units like Grantham. If it was a choice between staying there or taking my chances with a trip down the A52, I know which one I’d pick no matter how bad things were.
Chloe and I had an imaginary line when we were driving back from Grantham. If we crashed, on one side of the line we would crawl towards Nottingham, on the other we’d head for Leicester. Similar lines between Boston and Leicester.