Performance measurement of intensive care services in hospitals: the case of Barbados

The Intensive Care Unit (ICU), being one of those vital areas of a hospital providing clinical care, the quality of service rendered must be monitored and measured quantitatively. It is, therefore, essential to know the performance of an ICU, in order to identify any deficits and enable the service providers to improve the quality of service. Although there have been many attempts to do this with the help of illness severity scoring systems, the relative lack of success using these methods has led to the search for a form of measurement which would encompass all the different aspects of an ICU in a holistic manner. The Analytic Hierarchy Process (AHP), a multiple-attribute, decision-making technique is utilised in this study to evolve a system to measure the performance of ICU services reliably. This tool has been applied to a surgical ICU in Barbados; we recommend AHP as a valuable tool to quantify the performance of an ICU.

Outcome of elderly patients undergoing open-heart surgery in a developing country

To evaluate and compare the outcome of open-heart surgery in elderly patients with a concurrent group of younger patients in a developing country, data of all adult patients who underwent open-heart surgery during the period of 3 years from January 1999 to December 2001 were collected prospectively. Demographic data such as age and gender, other data such as preoperative diagnoses, comorbid illnesses, type of surgery, time of cardio-pulmonary bypass, length of stay and hospital outcome were recorded. The characteristics of patients above the age of 65 years were compared with a concurrent cohort of patients aged less than 65 years. One hundred and forty-five adult patients underwent open-heart surgeries in 3 years, and the overall mortality rate was 4.8 per cent. The much common surgeries were coronary artery bypass grafting, valve repair/replacement surgery and surgery for adult congenital heart diseases. Forty-five (31 per cent) patients were above the age of 65 years. The mortality rate was 2.2 per cent for patients who were aged 65 years and above, in comparison with that of the concurrent cohort of younger patients (6 per cent). This was probably because of more number of surgeries for congenital heart diseases in the latter group. However, even with other surgeries such as coronary artery bypass grafting, the elderly group of patients did equally well as the younger group. Elderly patients tolerate cardiac surgery well, and age should not be an exclusive criterion to decide against open-heart surgery.

Anaesthesia without nitrous oxide

Nitrous oxide has a long history of successful use in inhalational anaesthesia. Nevertheless questions are being raised over possible deleterious effects which may complicate its routine use. As more potent volatile agents have become available, compressed air/oxygen mixtures are gradually replacing nitrous oxide as a carrier gas in inhalational anaesthesia. We recommend that compressed air be installed on all anaesthetic machines and that in future, machines be designed so as to make it impossible to administer both nitrous oxide and air simultaneously (AU)