Analysing the Workload from HIV Inpatients: A 10-Month Retrospective Study

Abstract

To assess the clinical and laboratory workload arising from human immunodeficiency virus (HIV)-related inpatient admissions in a London teaching hospital, a 10-month retrospective audit was performed of the casenotes of all HIV-infected inpatients admitted under the care of one consultant physician. During this period, 84 inpatients were identified who generated 371 admissions, of whom 71 (84.5%) had acquired immunodeficiency syndrome (AIDS). Over two-thirds of admissions were essentially day cases, attributed to blood transfusions, antimicrobial and tumour chemotherapy, and minor surgery; with blood transfusions alone accounting for 43% of all admissions. Pulmonary infections (pyogenic and cell-mediated opportunist) accounted for 46 (12%) of admissions, with Pneumocystis carinii pneumonia second only to blood transfusions in caseload prevalence score (see below). Neurological complications of AIDS were associated with the longest admissions. Laboratory-based investigations were heavily utilized by AIDS inpatients, particularly bacteriological services. Choice of radiological investigation correlated with the anatomical site of disease presentation: plain radiology for chest symptoms, ultrasound for abdominal symptoms and computerized tomography (CT scanning) for neurological presentations. Drug-induced anaemia accounted for a substantial number of HIV-related admissions for red cell transfusions, which together with the disproportionate workload from daycase-type admissions, might be better handled in lower dependency day wards.