Abstract
Organisation of critical care services affects patient outcomes, as does the quality of care preceding intensive care unit (ICU) admission. Opportunities for improvement in both these spheres were identified in a district hospital high dependency unit (HDU). Changes were made to the medical and nursing leadership and staffing in HDU including enhanced ICU clinician and nursing responsibility for patient care, admission and discharge, development of a common critical care nursing pool, dedicated daytime supervised trainee medical staff and the option for ward staff to refer patients for an HDU evaluation. Data evaluating the number of patients admitted to ICU, requiring invasive ventilatory support and requiring renal replacement therapy were collected in real time on the existing Scottish Intensive Care Society database and retrospectively analysed using statistical process control (SPC) chart methodology. Organisational changes in HDU care were associated with SPC evidence of statistically significant reductions in patients receiving invasive ventilation, number of patient ventilation days, level 3 care days and renal replacement therapy days. Changing the organisation of HDU care in our setting was associated with marked changes in the pattern of intensive care use. It reduced the number of people receiving invasive ventilation and reduced number of ventilation, level 3 and renal replacement therapy days.