Health Care Needs Assessment

The Epidemiologically Based Needs Assessment Reviews, v. 2, First Series

Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson

• Publisher: CRC Press
• Year: 2018
• eBook ISBN: 9781315347424
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This new resource in the series provides vital perspectives across entire new disease and service areas not previously covered in other volumes. The books of the first and second series are well established as the key sources of data on needs assessment. Together, they describe the central role and aim of health care needs assessment in the National Health Service. The epidemiological approach to needs assessment is explained thoroughly, and is then applied to the effectiveness and availability of services. This definitive guide is ideal for all those involved in commissioning health care. It is invaluable for public health professionals, epidemiology and public health academics, and students of public health and epidemiology. Key reviews of the First Series: "An excellent balanced account...the definitive resource" - "Journal of the Association for Quality in Healthcare". "Excellent...it should be delved into deeply" - "Pharmaceutical Times". "This excellent work moves us closer to implementing a market in health care" - "British Medical Journal".

1 Adult Critical Care

Eugenia Cronin, Mick Nielsen, Martin Spollen and Nigel Edwards

1 Summary

Introduction

Adult critical care is an important, high-profile and high-cost area of modern healthcare provision. This chapter aims to provide an objective synthesis of evidence available from published and other sources that can inform debate on the planning of critical care services.

Definition of critical care

The term critical care has been defined as:

care for patients who have potentially recoverable conditions who can benefit from more detailed observation (with or without invasive treatment) than can be provided safely in an ordinary ward.¹

Background to the development of critical care services

Critical care services are atypical in the wide heterogeneity of their patients. This is in part a reflection of the way in which these services have evolved.

The progress of intensive care in the UK has been described as ‘haphazard’, consisting of ‘largely unplanned and unevaluated’ developments that occurred in reaction to changes in surgical and medical practice.

There has been debate about the configuration of critical care services, fuelled by a perception that there are not enough beds in some parts of the country and that existing beds are not in the right places.

During the late 1990s, the NHS Executive established a National Expert Group to review adult critical care services in the UK and to produce a national Framework for future organisation and care delivery. As a result, in May 2000 a critical care modernisation plan was announced.

Scope of this chapter

Throughout this chapter, we present and discuss both UK and international research findings on adult critical care services. Data on the profile of service provision, utilisation and associated costs relate to England and Wales unless otherwise stated.

Critical care services have previously been differentiated into intensive care and high-dependency care. The critical care modernisation plan announced in May 2000 introduced the notion that adult acute care should be seen as a spectrum, classified across four levels, much as paediatric critical care is organised. The four levels are:

•Level 0 – normal acute ward care

•Level 1 – acute ward care, with additional advice and support from the critical care team

•Level 2 – more detailed observation or intervention

•Level 3 – advanced respiratory support alone, or basic respiratory support together with support of at least two organ systems.

Sub-categories

In contrast with needs assessments for disease groups, where disease classification is central to the discussion and is relatively straightforward, in critical care practice it is difficult to classify and group clinical data into defined categories or hierarchies. Healthcare Resource Groups (HRGs) or Diagnosis Related Groups (DRGs) are used to categorise patients on the basis of diagnosis; but this approach is not applicable in critical care, where there is wide heterogeneity within diagnostic groups.^?

Patients can be categorised by severity of illness; on the basis of demographic characteristics; on more precise measures of severity of illness; or according to the organ systems needing monitoring or support.

Epidemiology of critical care

Age and gender

There is evidence that critical care patients are mostly males and that a high proportion are elderly.

Intensive Care National Audit and Research Centre (ICNARC) data show that 4.8% of admissions are in the age range 0–17, and that 46.5% of admissions are of people aged 65 years or over. The mean age of patients is 57.3 years.

Types of admission

Intensive care

There is evidence that the greatest proportion of admissions to ICUs are for medical emergencies (41%), followed by planned admissions from elective surgery (25%) and emergency surgical admissions (18%). There are more recent data suggesting that the proportion of non-surgical admissions to ICUs is increasing.

The most common source of admission to intensive care is theatre or recovery in the same hospital (44.1%), followed by a ward in the same hospital (22.3%) and A&E in the same hospital (17.1%).

High-dependency care

There is little information available on the types of admission and diagnostic categories of patients in HDUs in the UK, but the Augmented Care Period (AGP) dataset, introduced in 1997, will go some way towards addressing this.

Several studies have examined the potential for using HDU beds to alleviate some of the demand on ICU beds, by differentiating between those patients requiring high-dependency care and those requiring intensive care.

The reclassification of critical care into three levels, announced in the critical care modernisation plan in May 2000, will lead to a better reflection of severity in activity data.

Indications for admission

One study reported that over 70% of admissions to ICUs were in the cardiovascular or respiratory categories. Other data show that the ten most frequent reasons for admission are:

•Aortic or iliac dissection or aneurysm – surgical

•Acute myocardial infarction – non-surgical

•Pneumonia, with no organism isolated – non-surgical

•Bacterial pneumonia – non-surgical

•Septic shock – non-surgical

•Primary brain injury – non-surgical

•Large bowel tumour – surgical

•Left ventricular failure – non-surgical

•Asthma attack in a new or known asthmatic – non-surgical

•Non-traumatic large bowel perforation or rupture – surgical.

The most common condition admitted made up only 6.5% of admissions, and the top ten conditions made up only 26.8% of admissions.

The ten conditions that use the grea...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Preface
• List of contributors
• 1 Adult Critical Care
• 2 Continence
• 3 Dyspepsia
• 4 Black and Minority Ethnic Groups
• 5 Hypertension
• 6 Obesity
• 7 Chronic Pain
• 8 Mental III Health in Primary Care
• 9 Peripheral Vascular Disease
• 10 Pregnancy and Childbirth
• 11 Health Care in Prisons
• Index