Analysis of referrals and triage patterns in a South African metropolitan adult intensive care service.

BACKGROUND Intensive care unit (ICU) beds are scarce resources in low- and middle-income countries. Currently there is little literature that quantifies the extent of the demand placed on these resources or examines their allocation. OBJECTIVES To analyse the number and nature of referrals to ICUs in the Pietermaritzburg metropolitan area, South Africa, over a 1-year period, to observe the triage process involved in selecting patients for admission. METHODS A retrospective review of the patients referred to ICUs at Grey's and Edendale hospitals, Pietermaritzburg, was performed over a year. The spectrum of patients was evaluated with respect to various demographics, and the current triage process was observed. RESULTS The Pietermaritzburg Metropolitan Critical Care service (PMCCS) received 2,081 patient referrals, 53.4% (1,111/2,081) of males and 46.6% (970/2,081) of females, with a mean patient age of 32 years. The majority of referrals were of surgical patients (39.3%, 818/2 081), followed by medical (18.9%, 393/2,081), trauma (18.6%, 387/2,081) and obstetrics and gynaecology (11.7%, 244/2,081). The chief indications for referral were the need for cardiovascular and respiratory support. Of these referrals, 72.0% (1,499/2,081) were accepted and planned for admission and 28.0% (582/2,081) were refused ICU care. Of the patients accepted, 60.7% (910/1,499) experienced delays prior to admission and 37.4% (561/1 499) were never physically admitted to the units. CONCLUSIONS The PMCCS receives a far greater number of patient referrals than it is able to accommodate, necessitating triage. Patient demographics reflect a young patient population referred with chiefly surgical pathology needing physiological support.