Unplanned post-operative admissions to the critical care unit at Kenyatta National Hospital

Abstract

Patients are admitted to critical care unitfrom theatre in two categories; planned admissions for whom the anesthetist decided preoperatively that the critical care unit admission would be necessary and unplanned admissions for which the need for critical care unit admission was not anticipated preoperatively. Admission to the critical care unit can be one or more of these reasons postoperatively; respiratory support by mechanical ventilation, circulatory support by inotropic support or for close observation of very sick patients secondary to other conditions. Unplanned admission patients are those who are identified to require. critical care within theatre. This can be at any time in the operating theatre room, within the post anaesthesia care unit or less than 48 hours after discharge from the post anaesthesia care unit. No similar study had been undertaken in KNH regarding unplanned CCU admissions post operation. This study was to evaluate post-operative admission in KNH CCU that were unplanned. It involved reviewing the patients' medical records both pre-operatively, intraoperatively and post-operatively to elucidate factors that may have influenced their unplanned admission to the CCU post-operatively. A total of 86 patients admitted to the CCU post-operatively as unplanned cases were reviewed. Their medical records were reviewed from pre-operative, intra-operative upto the post-operation period before their admission to the CCU. These records were entered into a data collecting form (appendix 3) and were later analyzed by a biostastician. Conclusion and Recommendation. Unplanned post-operation admissions to the Kenyatta National Hospital is relatively high. Laparatomies dominated the cases. These were general laparatomies and obstetric laparatomies due to either antepartum or post-partum hemorrhage. Most admission occurred after working hours and were mostly attended by resident surgeons with their counterpart anaesthesia residents or registered clinical officer anaesthetist who are on duty during those odd hours. It is therefore necessary to foresee and plan for these admission either pre-operatively or intra-operative and inform the CCU team in good time. The residents should be free to consult their consultants and equally their consultants should be ready and willing to offer guidance during those odd hours.