Analysis of unscheduled admissions of patients undergoing elective surgery to the Intensive Care Unit

Background and goal: Unplanned admissions of patients undergoing elective surgery to the Intensive Care Unit (ICU) demonstrate an inadequate process of medical treatment. Moreover, under the conditions of DRG-based sanitary systems they may interfere with the efficiency of the delivery of medical care. An unplanned admission to the ICU induces additional costs in an economically relevant manner and an increased length of stay in the hospital for the single case as well as for sequential cases when bottle necks in medical processes are induced. Material and methods: We evaluated 3,000 admissions to the surgical ICUs of tertiary care hospitals during a 6-month period in a prospective 6 centre study. Purpose of the study was to describe the incidence, the reasons and the avoidance of the unplanned admissions of patients undergoing elective surgery. Results: 58 patients (1,9%) were classified as unplanned admissions after elective surgery. We found medical reasons in 83% of the admissions and organisational reasons in 17% of the cases. 77% of the admissions were associated to surgical complications compared to 23% of the admissions with complications related to anaesthesia. The most frequent organisational reason was the closure of the post anaesthesia care unit whereas postoperative hypothermia and residual effects of intraoperative anaesthetics remained the most frequent reason related to anaesthesia care. 47% of the admissions were classified as potentially avoidable. Conclusions: 1,9% of the admissions to the ICUs of tertiary care hospitals were unplanned admissions after elective surgery. Almost a half of these admissions were avoidable. An adequate seize and opening time of the post anaesthesia care unit or an intermediate care unit is required for compensation of these problems as well as the avoidance of perioperative hypothermia. and residual effects of intraoperative anaesthetics. Those perspectives of rationalisation consist of a reduction of perioperative costs and length of hospitalisation.