Malaysia Registry of Intensive Care 2009
Malaysian
Registry of
Intensive Care
Report for 2009
Malaysian Registry of Intensive Care
Report for 2009
(Previously known as National Audit of Adult Intensive Care Units)
Prepared by
Technical Committee of
Malaysian Registry of Intensive Care
2
May 2010
© Malaysian Registry Of Intensive Care
Published by:
Malaysian Registry of Intensive Care
Clinical Research Centre
Ministry of Health Malaysia
Disclaimer:
This work may be reproduced in whole or part for study or training purposes, subject
to the inclusion of an acknowledgement of the source.
Suggested citation:
Jenny MG Tong, LL Tai, CC Tan, Ahmad S, Asniza, CH Lim
Malaysian Registry of Intensive Care 2009 report
Electronic version:
This report can be downloaded at MRIC website: www.mric.org.my
3
CONTENTS
Contents…………………………………………………………………………………….
Page
4
Report Summary…………………………………………………………………………...
5
Acknowledgement…………………………………………………………………………
6
Foreword……………………………………………………………………………………
7
MRIC Technical Committee 2009……………………………………………………….
8
Participating Hospitals……………………………………………………………………
9
Categories of ICU ………………………………………………………………………….
10
Site Investigators and Source Data Providers 2009…..…………………………………
11
Abbreviations………………………………………………………………………………
14
List of Tables……………………………………………………………………………….
15
List of Figures………………………………………………………………………………
16
Introduction………………………………………………………………………………..
17
Results
Section A
General Information……………………………………………………
19
Section B
Patient Characteristics…………………………………………………
24
Section C
Interventions……………………………………………………………
40
Section D
Complications………………………………………………………….
48
Section E
Mortality Outcomes…………………………………………………...
57
Summary
64
References
4
REPORT SUMMARY
This is the report on all intensive care admissions to the 31 participating centres from 1
January to 31 December 2009.
The following are the main findings:
1.
The total number of ICU beds in the 31 participating units was 330 with a bed
occupancy rate of 87%.
2.
The number of cases analysed was 21226, an increase of 12% over the previous
year.
3.
The overall reporting rate had been fairly constant at 89%.
4.
The percentage of patients denied admission due to the unavailability of ICU
beds had declined from 56.5% to 40.0% in the last four years.
5.
The average age of the patients, excluding those below 18 years, was 50.3 years.
6.
The average lengths of ICU and hospital stay were 4.4 and 14.4 days
respectively.
7.
In MOH hospitals, 62% of ICU admissions were non-operative patients.
8.
Direct admissions to ICU from the emergency department had increased from
9% in 2004 to 21% in 2009.
9.
62% of ICU admissions had one or more organ failure within 24 hours of
admission.
10.
Head injury, sepsis and community-acquired pneumonia were the three most
common diagnoses leading to ICU admission in MOH hospitals. This trend
had remained the same over the past 7 years. The in-hospital mortality rates for
this group of patients were 27.0%, 62.2% and 46.3% respectively.
11.
The average SAPS II score was 35.8, which carries a predicted risk of inhospital mortality of 28.0%.
12.
In MOH hospitals, 79.3% of patients received invasive ventilation with an
average duration of 4.3 days.
13.
The percentage of patients who received non-invasive ventilation increased
from 6.5% in 2003 to 13.3% in 2009.
14.
The incidence of VAP decreased by more than half, from 28.0 to 11.6 per 1000
ventilator days, in the last seven years.
15.
The crude in-ICU and in-hospital mortality rates were 21.2% and 29.7%
respectively.
16.
The mean standardised mortality ratio was 0.89, (95% C.I. 0.86 – 0.91).
5
ACKNOWLEDGEMENT
The Malaysian Registry of Intensive Care would like to thank the following:
All site investigators and source data providers
The heads of Department of Anaesthesia and Intensive Care of participating ICUs
Staff of the participating ICUs
Quality of Health Care Section, Medical Development Division, Ministry of Health
Clinical Research Centre, Ministry of Health
and
All who have contributed in one way or another to MRIC
6
FOREWORD
This is the 7th report of the intensive care database started in 2002, under the ambit of
National Audit of Adult Intensive Care Units (NAICU). Although there has been a restructuring of the organisation and even a name change (now called Malaysian
Registry of Intensive Care, MRIC), the activity of auditing the intensive care practice in
Ministry of Health hospitals has continued to grow and this report is the culmination
of that effort.
In the last two years, MRIC had faced uncertainties in funding and technical support.
Thankfully the problem has been resolved. The Malaysian Society of Intensive Care
(MSIC) is now the main sponsor of the activity while the Clinical Research Centre
(CRC) provides the backend server support and the Quality Unit, Medical
Development Division, the administrative assistance. This arrangement will
undoubtedly provide a conducive environment for future development.
I would like to express my utmost appreciation to my colleagues in the National
Technical Committee under the leadership of Dr. Jenny Tong, for their commitment
and hard work during this trying period. Not only has the MRIC persevered, it has
achieved remarkable success in migrating the electronic records from stand-alone
units to a web-based programme. In these seven years, the number of centres recruited
had grown from 14 to 31; the number of intensive care beds studied from 100 to 330
and the number of patients analysed from 7,000 to 22,000. This two to three-fold
increase is testament of the strength and success of MRIC.
Clinicians’ support has been, and will remain, essential to the future of the registry.
Ultimately, the purpose of the registry is to improve quality of care. The Anaesthetic
and Intensive Care Service in Ministry of Health, with the support of the
administrators and health managers has achieved improvement in access and patient
outcome. The percentage of patients denied ICU admission and the incidence of
ventilator-associated pneumonia have declined over the years. In the coming year, the
focus will be on other quality improvement activities such as central venous catheter
care bundle and skin care bundle. I am confident that similar trends in improving
patient safety will continue.
Dr Ng Siew Hian
National Advisor
Anaesthetic and Intensive Care Service
Ministry of Health
7
TECHNICAL COMMITTEE
MALAYSIAN REGISTRY OF INTENSIVE CARE 2009
Advisor
Dr. Hjh Kalsom Maskon
Deputy Director (Quality of Health Care Section)
Medical Development Division, Ministry of Health
Dr. Ng Siew Hian
Consultant Anaesthesiologist and Head
Department of Anaesthesia and Intensive Care
Hospital Kuala Lumpur
Principal Investigator
Dr. Jenny Tong May Geok
Consultant Anaesthesiologist and Head
Department of Anaesthesia and Intensive Care
Hospital Tuanku Ja’afar Seremban
Co-Investigators
Dr. Tai Li Ling
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Kuala Lumpur
Dr. Tan Cheng Cheng
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Sultanah Aminah Johor Bahru
Dr. As-niza Abdul Shukor
Consultant Anaesthesiologist and Head
Department of Anaesthesia and Intensive Care
Hospital Taiping
Dr. Ahmad Shaltut Othman
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Sultanah Bahiyah Alor Setar
Dr. Lim Chew Har
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Pulau Pinang
Medical Development
Division,
Ministry of Health
Dr. Paa Nasir Abdul Rahman
Principal Assistant Director
Dr. Fakhruddin Amran
Assistant Director
Puan Nor Wati Mohd
8
PARTICIPATING HOSPITALS
No.
Name of hospital
Abbreviation
Sites since 2002
1.
Hospital Sultanah Bahiyah Alor Setar
AS
2.
Hospital Pulau Pinang
PP
3.
Hospital Raja Permaisuri Bainun Ipoh
IPH
4.
Hospital Kuala Lumpur
KL
5.
Hospital Selayang
SLG
6.
Hospital Tengku Ampuan Rahimah Klang
KLG
7.
Hospital Tuanku Ja’afar Seremban
SBN
8.
Hospital Melaka
MLK
9.
Hospital Sultanah Aminah Johor Bahru
JB
10.
Hospital Tengku Ampuan Afzan Kuantan
KTN
11.
Hospital Sultanah Nur Zahirah Kuala Terengganu
KT
12.
Hospital Raja Perempuan Zainab II Kota Bharu
KB
13.
Hospital Umum Sarawak Kuching
KCH
14.
Hospital Queen Elizabeth Kota Kinabalu
KK
Sites since 2005
15.
Hospital Sultan Abdul Halim Sungai Petani
SP
16.
Hospital Putrajaya
PJY
17.
Hospital Pakar Sultanah Fatimah Muar
MUR
18.
Hospital Teluk Intan
TI
19.
Hospital Taiping
TPG
20.
Hospital Seberang Jaya
SJ
21.
Hospital Kajang
KJG
22.
Hospital Tuanku Fauziah Kangar
KGR
Sites since 2006
23.
Sime Darby Medical Centre Subang Jaya
SDMC
24.
Hospital Sultan Haji Ahmad Shah Temerloh
TML
25.
Hospital Tuanku Ampuan Najihah Kuala Pilah
KP
26.
Hospital Sri Manjung
SMJ
27.
Hospital Batu Pahat
BP
28.
Hospital Tawau
TW
29.
Hospital Miri
MRI
30.
Hospital Kulim
KLM
31.
Hospital Serdang
SDG
9
CATEGORIES OF ICU
Based on the number of ICU beds (for the purpose of MRIC 2009 report)
Participating sites with 12 ICU beds or more (as of 30th June 2009)
1.
Hospital Sultanah Bahiyah Alor Setar
2.
Hospital Raja Permaisuri Bainun Ipoh
3.
Hospital Taiping
4.
Hospital Kuala Lumpur
5.
Hospital Selayang
6.
Hospital Tengku Ampuan Rahimah Klang
7.
Hospital Melaka
8.
Hospital Sultanah Aminah Johor Bahru
9.
Hospital Sultanah Nur Zahirah Kuala Terengganu
10.
Hospital Raja Perempuan Zainab II Kota Bharu
Participating sites with less than 12 ICU beds (as of 30th June 2009)
11.
Hospital Tuanku Fauziah Kangar
12.
Hospital Pulau Pinang
13
Hospital Tengku Ampuan Afzan Kuantan
14.
Hospital Tuanku Ja’afar Seremban
15.
Hospital Umum Sarawak Kuching
16.
Hospital Queen Elizabeth Kota Kinabalu
17.
Hospital Seberang Jaya
18.
Hospital Sultan Abdul Halim Sungai Petani
19.
Hospital Teluk Intan
20.
Hospital Kajang
21.
Hospital Pakar Sultanah Fatimah Muar
22.
Hospital Putrajaya
23.
Hospital Serdang
24.
Hospital Sultan Haji Ahmad Shah Temerloh
25.
Hospital Tuanku Ampuan Najihah Kuala Pilah
26.
Hospital Sri Manjung
27.
Hospital Batu Pahat
28.
Hospital Tawau
29.
Hospital Miri
30.
Hospital Kulim
Private hospital
31.
Sime Darby Medical Centre Subang Jaya
10
LIST OF SITE INVESTIGATORS AND SOURCE DATA COLLECTORS
January – December 2009
No
Hospital
Site investigator
Data collectors
1
Sultanah Bahiyah Alor
Setar
Dr Ahmad Shaltut
Othman
SN Azura bte Che Don (Jan-Sept
2009)
SN Mazni bte Abas (Jan-Sept 2009)
SN Hafisoh Ahmad (Oct-Dec 2009)
SN Haslina Khalid (Oct-Dec 2009)
Sr Teoh Shook Lian
SN Seniwati bt Salleh
2
Pulau Pinang
Dr Lim Chew Har
SN Khairulniza bt Razar
SN Rosmalizawati bt Ibrahim
SN Siti Hazlina bt Bidin
3
Raja Permaisuri Bainun
Ipoh
Dr Azlina Muhamad
SN Khairiah bt Mat Daud
SN Saadiah bt Bidin
4
Kuala Lumpur
Dr Tai Li Ling
SN Prema Chitrasenan
SN Alice Nesamany Thangapandi
(Jan-Sept 2009)
5
Selayang
Dr Haslinda Abd Hashim
(Jan-Oct 2009)
Dr Laila Kamariah
(Oct-Dec 2009)
SN Norzaila bte Saad
SN Noor Azawati bt Daud
6
Tengku Ampuan
Rahimah Klang
Dr Faezah bt Shaari
SN Latifah bt Omar
SN Norlaili bt Ismail
7
Tuanku Ja’afar Seremban
Dr Jenny Tong May Geok
Sr Chew Bee Ngoh
SN Farawahida bt Ahmad
8
Melaka
Dr Anita Alias
SN Morni bt Omar
9
Sultanah Aminah Johor
Bahru
Dr Tan Cheng Cheng
SN Aisah bt Abu Bakar
AMO Mohd Zakuan bin Mohd Nor
AMO Anuar bin Ismail
AMO Hairizam bin Zulkhifli
10
Tengku Ampuan Afzan
Kuantan
Dr Rusnah bte Ab.
Rahman
SN Aminah bte Abd Hamid
Sr Noorhani bt Kassim
11
Sultanah Nur Zahirah
Kuala Terengganu
Dr Mohd Ridhwan bin
Mohd Nor
SN Zauwiah bt Idris
SN Norhayati bt Abd Rosman
12
Raja Perempuan Zainab
II Kota Bharu
Dr Mat Ariffin Saman
(Jan-Oct 2009)
Dr Wan Nasrudin bin
Wan Ismail
(Oct-Dec 2009)
SN Azilah bt Ishak
SN SN Azizum bt Ismail
SN Haryati bt Hassan
11
13
Umum Sarawak Kuching
Dr Intan Zarina bt Fakir
SN Norelsa bt Daim
SN Sabia Lew
SN Rosmica Jiton
14
Queen Elizabeth Kota
Kinabalu
Dr Khoo Tien Meng
SN Doren Abel (Jan-Oct 2009)
SN Jusim Lugu
SN Conny Chong Chiew Fah (OctDec 2009)
15
Sultan Abdul Halim
Sungai Petani
Dr Ahmad Zaini b Mohd
Salleh
SN Halijah Hasim
SN Rafiza Md Zuki
Sr Puziah bt Yahya
16
Putrajaya
Dr Fauziah bt Yusoff
SN Noryasni bt Mahtrod @Ahamed
SN Latifah bt Mohd Korib
Sr Noorainee bt Romi
17
Pakar Sultanah Fatimah
Muar
Dr Yogabigai
Balasundram
SN Ropeah bt Ahmad
SN Roslina bt Othman
18
Teluk Intan
Dr Khairudin bin Zainal
Abidin
(Jan-Dec 2009)
Dr Wang Shir Siong
(Dec 2009)
SN Azliza bt Zakaria
SN Rohayu Dalila bt Yusof
AMO Mohd Najib bin Misbah
19
Taiping
Dr As-niza Abdul Shukor
SN Umi Khatijah bt Bani
SN Saleha bt Salleh
20
Seberang Jaya
Dr Jainisda bt Zainuddin
SN Zuraina bt Muhamad
SN Nooraslina bt Othman
SN Noorazleena bt Hasim
21
Kajang
Dr Wan Hafizah bt Wan
Tajul Ariffin
SN Faiza bt Mat Yusof
22
Tuanku Fauziah Kangar
Dr Azilah bt Desa
SN Zarina Mat Bistaman
SN Julaida bt Din
SN Zulminarni bt Ariffin
23
Sime Darby Medical
Center Subang jaya
Dr Alan Wong Ket Hiung
SN Navjeet Kaur
SN Normazimah bt Mohamad Nazar
24
Sultan Haji Ahmad Shah
Temerloh
Dr.Rahimah bt Haron
SN Rakiah bt Mohd Noor
SN Zaiton bt Isa
25
Tuanku Ampuan Najihah
Kuala Pilah
Dr.Sharuddin bin Musa
(Jan-May 2009)
Dr Zalifah bt Nordin
(May-Dec 2009)
SN Noormaisah bt Mohd Derus (JanMay 2009)
SN Noorliza bt Othman (May-Dec
2009)
Sr Lee New
12
26
Sri Manjung
Dr.Tin Tin Myint
Sr Rohana Ali
SN Hartini A.Rahman
27
Batu Pahat
Dr.Azmiza bt Mahani
(Jan-July 2009)
Dr Azizul Hisham b
Bahari (July-Dec 2009)
SN Zaidah bt Othman (Jan-Aug 2009)
SN Rosmawati bt Saimin
28
Tawau
Dr.Kyaw Soe
SN Lilybeth Feliciano Perez
SN Sarwah bt Isa
29
Miri
Dr Noorhafizah bt
Ghazali
SN Norlida bt Daud
SN Zurina bt Achim
30
Kulim
Dr.Chua Kok Boon
Dr Loh Hoong Heng
SN Mohana bt Omar
SN Bahayah bt Mohamed Bakairi
Sr Mahani bt Hassan
31
Serdang
Dr.Mohd Yani Bahari
SN Zamzurina bt Jahaya
SN Norain bt Mohd Saad
SN Siti Ainah bt Buang
13
ABBREVIATIONS
Adm.
Admission
AMO
Assistant medical officer
AOR
At own risk
APACHE II
Acute Physiologic and Chronic Health Evaluation (Version II)
CRRT
Continuous renal replacement therapy
ED
Emergency department
ENT
Otorhinolaryngology
HD
Haemodialysis
HDU
High dependency unit
Hosp
Hospital
ICU
Intensive care unit
Int.
Intensive
MOH
Ministry of Health
MRIC
Malaysian Registry of Intensive Care
MV
Mechanical ventilation
NA
Not available
NAICU
National Audit on Adult Intensive Care Units
NIV
Non-invasive ventilation
NHSN
National Healthcare Safety Network
NNIS
National Nosocomial Infection Surveillance
No.
Number
O&G
Obstetrics & Gynaecology
Refer.
Referred
SAPS II
Simplified Acute Physiologic Scoring System (Version II)
SD
Standard deviation
SMR
Standardised mortality ratio
SN
Staff nurse
SOFA
Sequential Organ Failure Assessment
Sr
Sister
SPSS
Statistical Package for Social Sciences
VAP
Ventilator-associated pneumonia
VCB
Ventilator care bundle
Yrs
Years
%
Percentage
14
LIST OF TABLES
Page
19
20
22
Table 1
Table 2
Table 3
Table 4
ICU beds and ICU bed occupancy rate, by MOH hospitals 2007-2009……………..
ICU admissions, by individual hospital 2004 – 2009…………………………………
Reporting rates, by individual hospital 2007 – 2009………………………………….
Intensive care referrals and refusal of admission, by individual hospital 2004 –
2009………………………………………………………………………………………...
Table 5
Table 6
Table 7
Table 8
Table 9
Table 10
Table 11
Table 12
Table 13
Table 14
Table 15
Table 16
Table 17
Table 18
Table 19
Gender 2004-2009………………………………………………………………………...
Mean age 2004-2009……………………………………………………………………..
Ethnic groups 2009……………………………………………………………………….
Length of ICU stay, by individual hospital 2004 – 2009……………………………...
Length of hospital stay, by individual hospital 2004 – 2009…………………………
Referring units 2009 ……………………………………………………………………..
Category of patients 2009……………………………………………….……………….
Category of patients in MOH hospitals 2004-2009 …………………………………...
Location before ICU admission, by hospitals 2009…………………………………...
Location before ICU admission in MOH hospitals 2004 – 2009…………………….
Indication for ICU admission 2009 …………………………………….……………....
Main organ failure on ICU admission 2009 ………………………….………………..
Number of organ failure(s) on ICU admission 200……………………………………
Ten most common diagnoses leading to ICU admission 2009 ……………………...
Ten most common diagnoses leading to ICU admission using APACHE II
diagnostic category 2009 ……………………………………………………………….
SAPS II score, by individual hospital 2003 – 2009 ……………………………………
SOFA score, by individual hospital 2007 – 2009 ……………………………………...
Invasive ventilation, non-invasive ventilation and reintubation 2009 ……………..
Duration of invasive ventilation, by individual hospital 2005 – 2009 …………………
Renal replacement therapy and modalities of therapy 2009………………………...
Tracheostomy 2009 …………………………………..………………………………….
Tracheotomy, by individual hospital 2009…………………………………………….
Tracheostomy, by individual hospital 2006-2009……………………………………..
Withdrawal /withholding of therapy, by individual hospital 2008-2009………….
Incidence of ventilator-associated pneumonia, by individual hospital 2003 –2009…
Onset of VAP from initiation of invasive ventilation, by individual hospital 2007
2009………………………………………………………………………………………….
Bacteriological cultures in VAP 2009 ………………………………………………….
Bacteriological cultures in VAP 2007 – 2009…………………………………………….
Unplanned extubation per 100 intubated days, by individual hospital 2003 – 2009…
Pressure ulcer, by individual hospital 2009 ……………………………………………
Hospital outcome 2009 ……………………………………………………………………
Crude in-ICU and in-hospital mortality rates, by individual hospital 2004 – 2009
Ten most common diagnoses leading to ICU admission and observed in-hospital
mortality in MOH hospitals 2009………………………………………………………
Interventions, complications and observed in-hospital mortality 2009…………….
Standardised mortality ratio by individual hospital 2004-2009……………………..
Table 20
Table 21
Table 22
Table 23
Table 24
Table 25
Table 26
Table 27
Table 28
Table 29
Table 30
Table 31
Table 32
Table 33
Table 34
Table 35
Table 36
Table 37
Table 38
Table 39
15
23
24
24
26
26
27
28
29
30
31
31
32
33
34
35
37
38
39
40
42
43
44
45
46
47
48
49
52
52
54
56
57
58
61
61
62
LIST OF FIGURES
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
ICU admissions, by participating centres 2009 …………………………………
ICU admissions 2003 – 2009…………………………………………………….
Age groups 2009 ………………………………………………………………...
Ethnic groups 2009 ……………………………………………………………...
Referring units 2009 ……………………………………………………………
Category of patients 2009 ………………………………………………………
Category of patients 2004 – 2009……………………………………………….
Location before ICU admission, by hospitals 2009 …………………………
Indication for ICU admission 2009 ……………………………………………
Main organ failure on ICU admission, by hospitals 2009 …………………...
Number of organ failure(s) on ICU admission, by hospitals 2009 ……………
Ten most common diagnoses leading to ICU admission in MOH hospitals
2009………………………………………………………………………………
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Figure 23
Figure 24
Figure 25
Figure 26
Figure 27
Figure 28
Figure 29
Invasive ventilation, by hospitals 2009 ………………………………………
Non-invasive ventilation, by hospitals 2009 …………………………………
Non-invasive ventilation, MOH hospitals 2003 – 2009 ……………………..
Re-intubation, MOH hospitals 2003 – 2009…………………………………..
Modalities of renal replacement therapy, by hospitals 2009 ………………
Techniques of tracheostomy, by hospitals 2009 ……………………………
VAP per 1000 ventilator days 2003 - 2009 …………………………………….
VAP per 1000 ventilator days, by individual hospital 2009………………..
VCB compliance and VAP 2007 – 2009………………………………………..
Bacteriological cultures in VAP 2009 …………………………………………
Unplanned extubation, by individual hospital 2009………………………..
Crude in-ICU and in-hospital mortality rates, by individual hospital 2009
Number of organ failure and mortality 2009 ………………………………..
SOFA score and observed in-hospital mortality 2009 ………………………
Category of patients and observed in-hospital mortality 2009……………..
Main organ failure and observed in-hospital mortality 2009 ………………
Standardised mortality ratio by individual hospital 2009…………………...
Page
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40
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43
44
50
50
50
53
55
59
59
60
60
60
63
16
INTRODUCTION
The National Audit on Adult Intensive Care Units (NAICU) was established in 2002
as a quality improvement initiative to systematically review the intensive care
practices in Malaysia and where possible, to introduce remedial measures to
improve outcome. To date, this audit had published six reports and introduced
several quality measures such as ventilator care bundle, central venous care bundle
and ICU networking.
In 2009, the NAICU underwent a major re-organisation and was renamed the
Malaysian Registry of Intensive Care. This report is thus the second for MRIC, but
seventh in the series. Following the change, MRIC has now become a member of the
national registry under the purview of Clinical Research Centre, Ministry of Health.
The objectives of the MRIC are to:
1. Establish a database of patients admitted to the adult ICUs
2. Review the clinical practices of intensive care
3. Determine clinical outcome
4. Determine the resources and delivery of intensive care service
5. Evaluate the impact of quality improvement measures on patient care
6. Provide comparisons of performance of participating centres against national
and international standards
7. Conduct healthcare research related to intensive care
This report describes the intensive care practices and outcomes in an ICU in a private
hospital and 30 ICUs in MOH.
Data Collection and Verification
Data were collected prospectively in all 31 ICUs by trained nurses (source data
providers) and specialists (site investigators) based on a written protocol. Data
initially collected on a case report form for each patient was subsequently transferred
to a customised software called SyNapse.. At three monthly intervals, the data was
‘burned’ into compact discs and sent to the coordinating centre in Hospital Kuala
Lumpur for ‘data merging’.
All participating centres were to ensure “accuracy and completeness” of their
individual databases before being uploaded and sent to the coordinating centre.
Merged data were ‘cleaned’ and verified before being analysed using SPSS version
10.0.1.
17
This report is based on all admissions into the 31 participating ICUs from 1 January
to 31 December 2009. Those admitted during this period but were still in hospital on
31 January 2010, were excluded from the analysis. The total number of admissions in
2009 was 22,234, out of which 968 (4.4%) were readmissions. For patients with
multiple ICU admissions, only the first admission was included in the analysis.
Due to missing and inconsistent data, the sum total of some variables shown in the
tables may not add up to the actual number of admissions.
Data Limitations
Limitations to the registry data were mainly related to the data entry and collection
process. Some of the participating ICUs experienced rapid turnover of their site
investigators and source data providers resulting in data inconsistencies. Some
centres encountered problems in accessing their local electronic database due to
hardware problems. Due to logistical problems, the technical committee of the MRIC
was unable to verify missing and inconsistent data with the specific participating
centres and to perform site visits.
Format of Report
The format of this report follows the patient journey in four sections: demographics,
interventions, complications and outcomes. Information is reported on a total of
21,266 ICU admissions.
In this report, information was provided for individual centres. Wherever
appropriate, comparisons were made between categories of hospitals based on the
number of ICU beds. In MOH hospitals the categories were centres with 12 beds or
more and those with less than 12 beds. Where relevant, trends of certain variables
over the years were reported.
The Future
The year 2009 was the last, when electronic records were collected on respective
computers before being sent to the coordinating centre in Hospital Kuala Lumpur
for data merging. From 1 January 2010 onwards, data entry will be performed webbased using a standard e-case report form. Another 6 six new centres (Hospitals
Sungai Buloh, Ampang, Sultan Ismail Pandan, Sibu, Duchess of Kent Sandakan and
Hospital Wanita & Kanak-Kanak Sabah) will be added to the list of participating
hospitals in the MRIC.
18
SECTION A:
Table 1:
Hospital
GENERAL INFORMATION
ICU beds and ICU bed occupancy rate, by MOH hospitals 2007 2009
Number of functional
ICU beds (as of 31-12-2009)
ICU bed occupancy rate %
2007
2008
2009
AS
14
66.2
80.5
88.6
PP
14
113.7
94.0
81.3
IPH
16
71.1
79.1
103.0
KL
30
112.3
112.7
108.6
SLG
16
75.7
80.2
72.6
KLG
22
98.4
100.5
198.7
SBN
8
111.8
110.4
111.8
MLK
22
84.7
87.3
84.2
JB
16
111.5
106.7
115.1
KTN
10
89.5
89.5
102.2
KT
16
101.3
109.2
115.2
KB
12
88.5
88.9
86.6
KCH
9
108.0
96.8
101.5
KK
9
109.7
125.3
87.3
SP
7
85.5
90.8
79.3
PJY
9
108.8
89.2
88.4
MUR
7
63.5
108.2
72.6
TI
4
107.0
83.0
86.5
TPG
18
61.5
83.5
83.6
SJ
8
76.7
68.7
101.9
KJG
6
78.4
74.2
75.8
KGR
5
87.8
79.1
71.8
TML
10
98.9
133.8
119.0
KP
4
62.9
57.8
51.0
SMJ
7
101.3
121.9
71.6
BP
4
74.5
86.4
77.0
TW
6
64.2
64.5
45.9
MRI
6
83.0
87.9
54.5
KLM
7
98.6
98.2
121.2
SDG
8
86.1
116.0
102.0
Total
330
-
-
-
Mean
-
89.4
93.5
97.3
Median
-
88.1
89.3
87.0
19
Table 2:
ICU admissions, by individual hospital 2004 – 2009
2004
Hospital
2005
2006
2007
2008
2009
n (%)
n (%)
n (%)
n (%)
n (%)
n (%)
AS
320 (4.4)
340 (4.6)
383 (3.8)
418 (3.2)
546 (3.2)
1121 (5.3)
PP
518 (7.2)
488 (6.5)
535 (5.3)
439 (3.3)
568 (3.3)
505 (2.4)
IPH
379 (5.3)
335 (4.5)
692 (6.8)
723 (5.5)
873 (5.1)
924 (4.3)
KL
991 (13.7)
1158 (15.5)
942 (9.3)
943 (7.2)
1578 (9.3)
1768 (8.3)
SLG
432 (6.0)
580 (7.8)
692 (6.8)
738 (5.6)
877 (5.2)
888 (4.2)
KLG
327 (4.5)
399 (5.3)
491 (3.9)
482 (3.7)
788 (4.6)
1080 (5.1)
SBN
304 (4.2)
295 (3.9)
292 (2.9)
427 (3.2)
467 (2.7)
510 (2.4)
MLK
717 (9.9)
666 (8.9)
634 (6.3)
1175 (8.9)
1366 (8.0)
1439 (6.8)
1026 (14.2)
920 (12.3)
1018 (10.1)
1074 (8.2)
1106 (6.5)
1245 (5.9)
KTN
475 (6.6)
478 (6.4)
432 (4.3)
513 (3.9)
563 (3.3)
613 (2.9)
KT
338 (4.7)
361 (4.8)
417 (4.1)
270 (2.1)
601 (3.5)
824 (3.9)
KB
422 (5.8)
469 (6.3)
442 (4.4)
725 (5.5)
847 (5.0)
803 (3.8)
KCH
503 (7.0)
528 (7.1)
594 (5.9)
461 (3.5)
464 (2.7)
461 (2.2)
KK
467 (6.5)
455 (6.1)
454 (4.5)
517 (3.9)
687 (4.0)
319 (1.5)
SP
-
-
202 (2.0)
119 (0.9)
183 (1.1)
261 (1.2)
PJY
-
-
234 (2.3)
NA
351 (2.1)
397 (1.9)
MUR
-
-
328 (3.2)
611 (4.6)
869 (5.1)
774 (3.6)
TI
-
-
318 (3.1)
253 (1.9)
281 (1.7)
262 (1.2)
TPG
-
-
259 (2.0)
684 (5.2)
412 (2.4)
867 (4.1)
SJ
-
-
412 (4.1)
59 (0.4)
504 (3.0)
599 (2.8)
KJG
-
-
228 (2.3)
146 (1.1)
142 (0.8)
265 (1.2)
KGR
-
-
211 (2.1)
238 (1.8)
268 (1.6)
302 (1.4)
SDMC
-
-
-
1842 (12.2)
1900 (10.0)
2085 (9.8)
TML
-
-
-
382 (2.9)
429 (2.5)
607 (2.9)
KP
-
-
-
140 (1.1)
193 (1.1)
165 (0.8)
SMJ
-
-
-
226 (1.70
347 (2.0)
336 (1.6)
BP
-
-
-
266 (2.0)
342 (2.0)
397 (1.9)
TW
-
-
-
256 (1.9)
316 (1.9)
215 (1.0)
MRI
-
-
-
180 (1.4)
267 (1.6)
212 (1.00
KLM
-
-
-
298 (2.3)
316 (1.9)
343 (1.6)
SDG
-
-
-
385 (2.9)
456 (2.7)
679 (3.2)
7219 (100)
7472 (100)
10110 (100)
14990 (100)
18907 (100)
21266 (100)
JB
Total
The number of admissions has increased over the years. The increase from 2008 to
2009 was about 12%. There was an increase in number of admissions in most centres.
Hospital AS and Hospital TPG had increases of more than 100% in admissions
compared to the previous year. This was attributed to expansion of their ICUs in 2009.
20
Figure 1:
Figure 2:
ICU admissions, by participating centres 2009
ICU admissions, 2003 - 2009
21
Table 3:
Reporting rates, by individual hospital 2007 – 2009
Hospital
2007
%
2008
%
2009
%
AS
86.7
91.3
93
PP
93.2
97.4
93
IPH
97.1
96.3
96
KL
98.4
98.9
95
SLG
99.2
99.7
84
KLG
99.4
90.9
92
SBN
97.7
99.6
97
MLK
99.9
99.3
92
JB
99.5
99.8
97
KTN
99.4
99.6
96
KT
49.6
98.2
90
KB
100.0
99.3
94
KCH
93.0
93.0
89
KK
75.2
90.3
60
SP
29.2
53.4
50
PJY
0
80.9
87
MUR
74.3
82.6
80
TI
87.6
102.2
97
TPG
99.9
46.6
95
SJ
20.1
99.0
96
KJG
54.0
57.7
87
KGR
82.2
91.8
94
TML
95.7
95.8
86
KP
89.4
98.0
98
SMJ
92.5
89.2
100
BP
90.9
97.2
90
TW
90.3
100.0
93
MRI
82.9
68.5
65
KLM
98.1
101.3
97
SDG
97.5
98.9
94
Total
82.4
89.9
89.0
The reporting rate is calculated by comparing the number of ICU admissions
reported to the MRIC and to the national census (collected by Anaesthetic program
head). The total number reported to the MRIC was slightly less than that to the
national census, as patients who were still in hospital on 31 January 2010 were
excluded in the analysis.
Overall, there was an improvement in the reporting rates from 82.4% in 2007 to 89%
in 2009. However, Hospitals KK. SP and MRI had poor reporting rates.
22
Table 4:
Hosp
Intensive care referrals and refusal of admission, by individual
hospital 2004 - 2009
2004
2005
No.
refer.
for int.
care
%
denied
adm.
%
denied
adm.
No.
refer.
for int.
care
AS
224
37.9
#
#
#
PP
827
70.5
1024
73.2
1054
IPH
789
90.4
872
91.6
351
KL
1795
32.5
2170
38.0
SLG
290
51.7
#
KLG
387
55.6
SBN
984
MLK
2007
%
denied
adm.
2008
No.
refer.
for int.
care
%
denied
adm.
#
429
78.1
1299
94.3
2294
#
737
74.6
116
JB
2009
No.
refer.
for int.
care
%
denied
adm.
No.
refer.
for int.
care
%
denied
adm.
76.2
227
81.8
1478
23.4
358
19.0
84.3
1407
82.3
635
77.2
633
79.5
612
82.5
38.4
2327
36.2
2512
34.4
2230
31.0
185
45.9
79
16.5
440
40.0
345
33.6
73.8
876
74.5
1490
82.3
1657
73.0
2072
64.2
1048
69.8
1330
66.0
1558
62.6
1770
65.5
1863
63.3
31.9
811
50.7
879
52.2
1085
43.2
940
62.1
981
56.0
1524
61.4
870
68.5
2066
57.2
2101
48.6
1638
49.0
1111
50.1
KTN
467
KT
398
37.0
454
35.0
447
36.9
811
33.3
768
28.3
755
20.4
43.0
404
30.2
476
29.2
160
20.6
385
26.8
105
30.5
KB
812
52.2
908
50.7
720
57.9
953
68.1
1067
67.1
1219
66.1
KCH
544
32.2
535
29.7
315
30.5
569
51.5
580
61.4
486
58.4
KK
115
67.8
#
#
249
48.6
299
60.9
294
60.9
378
7.9
SP
-
-
-
-
#
#
95
60.9
137
42.3
48
18.8
PJY
-
-
-
-
#
#
#
#
212
#
#
#
MUR
-
-
-
-
#
#
575
18.1
542
32.1
#
#
TI
-
-
-
-
#
#
211
9.5
52
5.8
#
#
TPG
-
-
-
-
488
62.9
685
5.7
499
15.4
1186
11.6
SJ
-
-
-
-
#
#
226
1.3
222
21.6
660
15.0
KJG
-
-
-
-
#
#
9
22.2
#
#
#
#
KGR
-
-
-
-
#
#
84
19.1
335
20.3
165
22.4
TML
-
-
-
-
-
-
416
22.1
303
44.6
68
35.3
KP
-
-
-
-
-
-
225
26.7
334
39.2
346
48.6
SMJ
-
-
-
-
-
-
192
35.4
236
26.7
174
17.8
BP
-
-
-
-
-
-
310
14.8
346
4.3
442
7.0
TW
-
-
-
-
-
-
248
0.0
326
#
#
#
MRI
-
-
-
-
-
-
116
25.0
168
14.5
126
29.4
KLM
-
-
-
-
-
-
289
17.7
291
12.7
302
10.6
SDG
-
-
-
-
-
-
162
27.8
299
43.1
698
30.8
9272
54.5
9833
56.5
12280
18689
48.3
18365
40.0
Total
No.
refer.
for int.
care
2006
53.4
17638
47.9
# Missing data
The percentage of patients who was refused admission due to unavailability of ICU
beds in 2009 was 40%, a significant improvement from 56.5% in 2005. However, 8
hospitals had high refusal rates of more than 50%.
23
SECTION B:
PATIENT CHARACTERISTICS
Table 5:
Gender 2004 - 2009
Gender
2004
n (%)
2005
n (%)
2006
n (%)
2007
n (%)
2008
n (%)
2009
n (%)
Male
4150 (57.5)
4406 (59.0)
5821 (57.6)
7654 (58.2)
11081 (58.7)
12489 (58.7)
Female
3058 (42.4)
3066 (41.0)
4289 (41.0)
5492 (41.8)
7811 (41.3)
8768 (41.3)
Table 6:
Age
Mean age (years) 2004 - 2009
2004
2005
2006
2007
2008
2009
All ages,
Mean + SD yrs
40.9 ± 21.2
42.3 ± 21.0
43.3 ± 20.8
45.0 ± 21.0
46.5 ± 20.9
46.5 ± 20.9
Age ≥ 18 years
Mean + SD yrs
-
-
-
50.3 ± 18.2
50.3 ± 18.1
-
The average age for all age groups was 46.5 + 20.9 years (median 48.4 years). For
adult patients, with age exceeding 18 years, the average age was 50.3 + 18.2 years
(median 51.5 years). The average age of patients admitted to ICUs had increased
over the years.
Figure 3 :
Age groups, 20009
Geriatric patients (age more than 65 years) and paediatric patients (age less than 12 years)
accounted for 23.5% and 3.8% of total admissions respectively.
24
Table 7:
Ethnic groups 2009
Ethnic group
n
%
Malay
Chinese
Indian
Foreigner
Bumiputra Sabah/Sarawak
Other Malaysian
Orang Asli
Unknown
12339
4427
2361
1006
755
363
152
43
58.0
20.9
11.1
4.7
2.6
1.7
0.7
0.2
Total
21266
100
Figure 4:
Ethnic groups 2009
The distribution of patients admitted to ICU reflected the distribution of the ethnic
groups in the general population in Malaysia. Foreigners constituted about 4.7% of
the ICU population.
25
Table 8:
Length of ICU stay, by individual hospital 2004 – 2009
Mean (Median), days
Hospital
2004
2005
2006
2007
2008
2009
AS
3.9
4.0
4.3
4.3 (2.4)
4.3 (2.4)
3.9 (2.2)
PP
5.0
5.5
4.5
5.2 (2.2)
4.6 (2.0)
5.4 (2.5)
IPH
5.1
5.8
5.1
5.4 (2.7)
5.1 (2.7)
5.1 (2.8)
KL
5.4
4.7
5.2
5.1 (2.9)
4.9 (2.4)
4.9 (2.8)
SLG
5.8
5.1
4.6
4.5 (2.6)
4.4 (2.7)
4.4 (2.7)
KLG
6.5
5.3
4.9
4.4 (1.9)
4.8 (2.7)
4.9 (2.7)
SBN
4.7
4.8
5.4
4.8 (3.0)
5.9 (3.0)
5.3 (2.9)
MLK
2.7
2.8
2.8
3.7 (1.9)
4.0 (2.0)
4.3 (2.1)
JB
5.2
5.9
4.8
4.9 (2.5)
4.9 (3.8)
4.5 (2.4)
KTN
3.9
3.9
4.2
4.2 (2.3)
4.8 (2.5)
4.7 (2.9)
KT
4.1
3.9
3.5
4.3 (2.3)
4.2 (2.6)
4.3 (2.7)
KB
5.4
4.6
4.5
4.8 (2.5)
4.5 (2.5)
4.4 (2.3)
KCH
3.8
3.4
3.3
4.7 (2.3)
5.5 (2.6)
5.4 (2.7)
KK
4.5
4.7
5.0
4.6 (2.3)
4.6 (2.0)
5.4 (2.9)
SP
-
-
5.1
6.4 (4.1)
7.3 (4.8)
3.9 (2.4)
PJY
-
-
-
-
4.5 (1.9)
4.4 (1.9)
MUR
-
-
5.7
5.1 (2.8)
4.4 (3.0)
4.4 (2.0)
TI
-
-
3.9
4.4 (2.5)
3.7 (2.4)
3.5 (2.1)
TPG
-
-
4.3
4.8 (2.5)
4.5 (2.8)
5.4 (2.7)
SJ
-
-
4.6
5.9 (1.9)
5.5 (2.5)
4.3 (2.6)
KJG
-
-
4.5
4.4 (2.7)
4.6 (2.5)
4.9 (2.6)
KGR
-
-
3.5
5.2 (2.1)
5.2 (2.8)
4.0 (2.7)
SDMC
-
-
-
2.5 (1.2)
2.5 (1.4)
2.3 (1.2)
TML
-
-
-
4.4 (2.2)
4.8 (2.7)
5.0 (2.8)
KP
-
-
-
5.4 (2.2)
4.2 (2.4)
4.9 (2.4)
SMJ
-
-
-
6.4 (2.5)
4.9 (2.7)
5.3 (3.0)
BP
-
-
-
5.5 (2.7)
5.6 (3.2)
4.3 (2.5)
TW
-
-
-
4.0 (2.3)
4.4 (2.0)
4.2 (2.2)
MRI
-
-
-
5.5 (3.1)
4.8 (2.8)
6.2 (3.0)
KLM
-
-
-
3.5 (2.2)
3.6 (2.4)
4.2 (2.6)
SDG
-
-
-
4.6 (2.10
4.5 (2.3)
4.3 (2.1)
4.7
4.6
4.5
4.7 (2.4)
4.7 (2.6)
4.4 (2.3)
Total
The mean length of ICU stay was 4.4 days and it had decreased compared with previous
years. SDMC recorded the shortest length of stay (2.3 days) while Hospital MRI reported the
longest stay of 6.2 days.
26
Table 9:
Length of hospital stay, by individual hospital 2004 – 2009
Mean (Median), days
Hospital
2004
2005
2006
2007
2008
2009
AS
16.8
14.9
14.8
14.2 (9.7)
15.5 (9.3)
12.6 (7.9)
PP
24.3
22.1
20.3
21.7 (14.0)
21.4 (13.7)
20.4 (11.5)
IPH
19.8
19.0
16.6
15.4 (10.6)
17.0 (10.6)
14.5 (10.0)
KL
22.9
18.7
19.6
19.7 (12.4)
20.1 (11.4)
18.5 (10.8)
SLG
20.3
17.6
17.1
17.2 (10.7)
16.9 (11.1)
17.1 (10.2)
KLG
19.2
17.0
15.9
15.7 (10.8)
18.8 (11.3)
15.5 (10.8)
SBN
16.7
15.8
17.1
16.6 (11.1)
20.4 (12.4)
16.0 (10.8)
MLK
15.0
14.0
12.5
13.6 (9.7)
14.6 (10.0)
13.6 (8.9)
JB
17.7
17.9
15.7
16.2 (11.3)
16.1 (10.4)
14.9 (10.0)
KTN
18.9
16.5
16.0
17.5 (12.1)
18.5 (12.4)
15.3 (10.9)
KT
16.6
14.4
16.1
15.2 (9.0)
16.7 (11.9)
13.2 (8.7)
KB
17.8
15.7
16.1
16.4 (10.7)
16.0 (10.9)
17.2 (10.7)
KCH
21.2
17.4
17.7
20.4 (13.1)
21.2 (14.1)
19.8 (12.8)
KK
22.8
22.8
23.3
29.5(19.0)
26.2 (15.2)
23.2 (14.9)
SP
-
-
14.0
11.4 (7.6)
14.4 (9.6)
10.5 (7.9)
PJY
-
-
-
-
13.8 (7.9)
13.5 (8.3)
MUR
-
-
17.9
15.7 (10.5)
17.6 (10.3)
15.8(10.2)
TI
-
-
12.3
10.8 (8.03)
11.7 (8.5)
11.6 (7.6)
TPG
-
-
15.6
12.0 (8.3)
11.6 (7.9)
12.5 (8.3)
SJ
-
-
10.7
14.5 (8.4)
12.9 (9.1)
11.0 (8.7)
KJG
-
-
13.3
13.9 (10.3)
12.6 (9.8)
13.8 (9.2)
KGR
-
-
14.5
18.1 (10.4)
15.6 (10.7)
16.3 (10.7)
SDMC
-
-
-
12.1 (5.7)
11.8 (5.9)
8.4 (5.1)
TML
-
-
-
13.9 (9.8)
15.5 (11.2)
14.0(10.4)
KP
-
-
-
13.8 (7.6)
11.3 (8.6)
12.9 (8.6)
SMJ
-
-
-
13.5 (9.0)
10.6 (6.8)
11.4(7.9)
BP
-
-
-
13.0 (7.7)
14.8 (9.9)
12.0 (8.4)
TW
-
-
-
12.4 (8.9)
15.8 (9.7)
13.3 (7.9)
MRI
-
-
-
15.2 (10.3)
14.6 (10.0)
15.1 (9.9)
KLM
-
-
-
11.4 (7.2)
10.3 (7.7)
10.8 (7.8)
SDG
-
-
-
16.6 (10.4)
17.1 (9.6)
15.8 (9.3)
19.5
17.6
16.4
16.3 (10.5)
15.9 (10.3)
14.4 (9.0)
Total
The average length of hospital stay had decreased over the years from 19.5 days in 2004 to
14.4 days in 2009. Hospital KK reported an average length of hospital stay that exceeded 20
days.
27
Table 10:
Referring units 2009
Hospitals
Referring units
Beds ≥ 12
n(%)
Beds < 12
n(%)
Private
n(%)
Total
n(%)
Medicine
4733 (43.2)
3475 (42.5)
720 (34.6)
8928 (42.1)
General Surgery
2876 (26.3)
2560 (31.3)
138 (6.6)
5574 (26.3)
832 (7.6)
678 (8.3)
169 (8.1)
1679 (7.9)
734 (6.7)
531 (6.5)
29 (1.4)
1294 (6.1)
141 (1.3)
12 (0.1)
30 (1.4)
183 (0.9)
Orthopaedic Surgery
O&G
Vascular Surgery
Paediatric Surgery
52 (0.5)
58 (0.7)
9 (0.4)
119 (0.6)
Neurosurgery
601 (5.5)
271 (3.3)
193 (9.3)
1065 (5.0)
Plastic surgery
52 (0.5)
38 (0.5)
10 (0.5)
100 (0.5)
ENT
205 (1.9)
156 (1.9)
68 (3.3)
429 (2.0)
Ophthalmology
14 (0.1)
10 (0.1)
2 (0.1)
26 (0.1)
Urology
107 (1.0)
38 (0.5)
56 (2.7)
201 (0.9)
Dental Surgery
85 (0.8)
35 (0.4)
2 (0.1)
122 (0.6)
Paediatric Medical
135 (1.2)
211 (2.6)
92 (4.4)
438 (2.1)
7 (0.1)
11 (0.1)
205 (9.8)
223 (1.1)
Cardiology
Haematology
3 (0.0)
8 (0.1)
19 (0.9)
30 (0.1)
Nephrology
151 (1.4)
60 (0.7)
84 (4.0)
295 (1.4)
Neurology
111 (1.0)
10 (0.1)
244 (11.7)
365 (1.7)
-
2 (0.0)
4 (0.2)
6 (0.0)
Cardiothoracic Surgery
Others
108 (1.0)
16 (0.2)
8 (0.4)
132 (0.6)
Total
10947 (100)
8180 (100)
2082 (100)
21209 (100)
Figure 5:
Referring units 2009
The proportion of patients admitted from the medical-based disciplines had steadily
increased from 29.5% in 2003 to 46.4% in 2009.
28
Table 11:
Category of patients 2009
Hospitals
Category of patients
Beds ≥ 12
n (%)
Beds < 12
n (%)
Private
n (%)
Total
Non-operative
6656 (60.8)
4953 (60.4)
1488 (71.5)
13097 (61.7)
Elective operative
1238 (11.3)
1020 (12.4)
466 (22.4)
2724 (12.8)
Emergency operative
3055 (27.9)
2226 (27.1)
128 (6.1)
5409 (25.5)
10949 (100)
8199 (100)
2082 (100)
21230 (100)
Total
Non-operative;
Operative elective:
Operative-emergency:
Figure 6:
Refers to patients in whom no surgery was done out within 7 days before ICU admission or
during the first 24 hours after ICU admission
Refers to patients in whom surgery was done within 7 days before ICU admission or during the
first 24 hours after ICU admission on a scheduled basis
Refers to patients in whom surgery was done within 7 days before ICU admission or during the
first 24 hours after ICU admission on an unscheduled basis
Category of patients 2009
The categories of patients did not differ between ICUs in MOH hospitals. However,
the proportion of emergency operative patients in the private hospital was
significantly less compared to MOH hospitals.
29
Table 12:
Category of patients in MOH hospitals 2004 - 2009
Category of patients
2004
(%)
2005
(%)
2006
(%)
2007
(%)
2008
(%)
2009
(%)
Non-operative
44.8
48.4
49.0
55.8
59.2
61.6
Elective operative
18.8
16.5
15.9
13.2
14.3
12.8
Emergency operative
34.4
35.1
35.1
31.0
26.5
25.4
Figure 7:
Category of patients 2004 - 2009
There was a steady increase in non-operative patients over the past 6 years with a
17% increase from 2004 to 2009. Correspondingly, the percentage of elective
operative and emergency operative patients decreased by 6% and 9% respectively
from 2004 to 2009.
30
Table 13:
Location before ICU admission, by hospitals 2009
Location
Beds ≥ 12
n (%)
Hospitals
Beds < 12
n (%)
Private
n (%)
Total
n (%)
Ward
3789 (34.6)
3393 (41.4)
496 (23.8)
7678 (36.2)
OT
3473 (31.7)
2550 (31.1)
441 (21.2)
6464 (30.5)
A&E
2471 (22.6)
1455 (17.8)
991 (47.6)
4917 (23.2)
Other critical area
549 (5.0)
285 (3.5)
5 (0.2)
839 (4.0)
Other location
83 (0.8)
46 (0.6)
110 (5.3)
239 (1.1)
Other hospital
583 (5.3)
462 (5.6)
39 (1.9)
1084 (5.1)
10948 (100.0)
8191 (100.0)
2082 (100.0)
21221 (100.0)
Total
Figure 8:
Location before ICU admission, by hospitals 2009
Table 14:
Location before ICU admission in MOH hospitals 2004 - 2009
Location
2004
(%)
2005
(%)
2006
(%)
2007
(%)
2008
(%)
2009
(%)
Ward
33.4
32.5
32.8
37.2
34.5
37.5
Operation theatre
42.8
45.4
40.6
35.7
36.2
31.5
Emergency department
9.0
9.3
12.6
13.2
16.7
20.5
Other critical areas
11.8
9.6
9.0
7.3
6.5
4.4
Other locations
0.2
0.4
0.5
0.4
0.6
0.7
Other hospitals
2.8
2.8
4.5
6.1
5.6
5.5
The percentage of admissions from the emergency department had increased
significantly more than two-fold over the last 6 years.
Inter-hospital transfers had also increased over the years.
31
Table 15:
Indication for ICU admission 2009
Indication
Beds > 12
n (%)
Hospitals
Beds < 12
Private
n (%)
n (%)
Mechanical ventilation
5853 (53.5)
4323 (52.8)
11 (0.5)
10187 (48.0)
Post-operative
ventilation
Planned
2998 (27.4)
1932 (23.6)
5 (0.2)
4935 (23.3)
Unplanned
419 (3.8)
283 (3.5)
12 (0.6)
714 (3.4)
Post-operative
monitoring/
intervention
Planned
559 (5.1)
580 (7.1)
285 (13.7)
1424 (6.7)
Unplanned
164 (1.5)
127 (1.6)
83 (4.0)
374 (1.8)
Non-operative
monitoring/intervention
949 (8.7)
938 (11.5)
1686 (81.0)
3573 (16.8)
Total
10942
(100.0)
8183
(100.0)
2082
(100.0)
21207
(100.0)
Planned admission:
Unplanned admission:
Figure 9:
Total
The decision for admission was made before the induction of anaesthesia.
The decision for admission was made after induction of anaesthesia.
Indication for ICU admission 2009
In 2009, more than 82.6% of ICU admissions had mechanical ventilation (including
postoperative ventilation) as an indication for admission in MOH hospitals
compared to 1.3% in the private hospital. Non-operative intervention and
monitoring was the main indication for ICU admission in the private hospital.
32
Table 16:
Main organ failure on ICU admission 2009
Hospitals
Main organ failure
Beds > 12
n (%)
Beds < 12
n (%)
Private
n (%)
Total
n (%)
Without organ failure
3404 (33.7)
2457 (34.1)
1422 (78.5)
7283 (38.1)
Cardiovascular
2696 (26.7)
1761 (24.5)
18 (1.0)
4475 (23.4)
Respiratory
1547 (15.3)
1450 (20.1)
40 (2.2)
3037 (15.9)
Neurological
1419 (14.0)
862 (12.0)
41 (2.3)
2322 (12.2)
Renal
592 (5.9)
382 (5.3)
138 (7.6)
1112 (5.8)
Haematological
357 (3.5)
209 (2.9)
139 (7.7)
705 (3.7)
Hepatic
85 (0.8)
76 (1.1)
13 (0.7)
174 (0.9)
10100 (100)
7197 (100)
1811 (100)
19108 (100)
Total
The definition of organ failure is based on the Sequential Organ Failure Assessment (SOFA) [1]
Figure 10:
Main organ failure on ICU admission, by hospitals 2009
In 2009, about a third of admissions to MOH ICUs did not have any organ failure in
comparison to the private hospital where two-thirds of admissions were without any organ
failure. In MOH ICUs, cardiovascular failure (39%) was the most common organ failure
during the first 24 hours of ICU admission, followed by respiratory (26%) and neurological
(20%). This is in contrast to 2003, where respiratory failure (57%) was the most common
organ failure followed by cardiovascular failure (19%).
33
Table 17:
Number of organ failure(s) on ICU admission 2009
Number of organ failure
Beds ≥ 12
n(%)
Hospitals
Beds < 12
Private
n(%)
n(%)
Without
3404 (33.7)
2457 (34.1)
1422 (78.5)
7283 (38.1)
Single
3087 (30.6)
2119 (29.4)
320 (17.7)
5526 (28.9)
Two
2272 (22.5)
1523 (21.2)
43 (2.4)
3838 (20.1)
Three
1020 (10.1)
792 (11.0)
18 (1.0)
1830 (9.6)
Four
271 (2.7)
253 (3.5)
8 (0.4)
532 (2.8)
Five
40 (0.4)
51 (0.7)
-
91 (0.5)
Six
6 (0.1)
2 (0.0)
-
8 (0.0)
10100 (100)
7197 (100)
1811 (100)
19108 (100)
Total
Figure 11:
Total
n(%)
Number of organ failure(s) on ICU admission 2009
In 2009, 38% of patients admitted to ICUs were without any organ failure, while 29%
had single organ failure. Many of the ICUs function as combined ICU/HDW and
this could be one of the reasons for the high proportion of patients admitted without
any organ failure.
34
Table 18:
Ten most common diagnoses leading to ICU admission 2009
Diagnosis
n
%
Head Injury
1120
10.2
Sepsis
848
7.7
Community acquired pneumonia
739
6.7
Gastrointestinal perforation (including anastomotic leak)
393
3.6
Dengue
388
3.5
Bronchial asthma
379
3.5
Chronic lower respiratory disease
321
2.9
Intraabdominal injury
285
2.6
Non-cardiogenic pulmonary oedema
257
2.3
Infection / gangrene of limb (including osteomyelitis,
251
2.3
Sepsis
806
9.8
Head injury
617
7.5
Community acquired pneumonia
572
7.0
Bronchial asthma
307
3.7
Gastrointestinal perforation ( including anastomotic leak)
281
3.4
Dengue
253
3.1
Chronic lower respiratory disease
240
2.9
Other abdominal / pelvic conditions
216
2.6
Gastrointestinal bleeding
210
2.6
Intraabdominal injury
200
2.4
Cerebrovascular disease
167
8.0
Ischaemic heart disease/ acute coronary syndrome
153
7.3
Dengue
150
7.2
Epilepsy
105
5.0
Gastrointestinal bleeding
104
5.0
Other CNS condition
97
4.7
Other disorders of the musculoskeletal system
96
4.6
Other abdominal/ pelvic conditions
95
4.6
Other renal / genito-urinary conditions
78
3.7
Other respiratory conditions
64
3.1
Hospitals with ICU beds ≥ 12
necrotizing fascitis)
Hospitals with ICU beds < 12
Private Hospital
35
Figure 12:
Ten most common diagnoses leading to ICU admission in MOH
hospitals 2009
Head injury, sepsis and community-acquired pneumonia remained the three most common
diseases leading to ICU admission in MOH hospitals over the past 6 years.
36
Table 19:
Ten most common diagnoses leading to ICU
Registry of
Intensive Care
Report for 2009
Malaysian Registry of Intensive Care
Report for 2009
(Previously known as National Audit of Adult Intensive Care Units)
Prepared by
Technical Committee of
Malaysian Registry of Intensive Care
2
May 2010
© Malaysian Registry Of Intensive Care
Published by:
Malaysian Registry of Intensive Care
Clinical Research Centre
Ministry of Health Malaysia
Disclaimer:
This work may be reproduced in whole or part for study or training purposes, subject
to the inclusion of an acknowledgement of the source.
Suggested citation:
Jenny MG Tong, LL Tai, CC Tan, Ahmad S, Asniza, CH Lim
Malaysian Registry of Intensive Care 2009 report
Electronic version:
This report can be downloaded at MRIC website: www.mric.org.my
3
CONTENTS
Contents…………………………………………………………………………………….
Page
4
Report Summary…………………………………………………………………………...
5
Acknowledgement…………………………………………………………………………
6
Foreword……………………………………………………………………………………
7
MRIC Technical Committee 2009……………………………………………………….
8
Participating Hospitals……………………………………………………………………
9
Categories of ICU ………………………………………………………………………….
10
Site Investigators and Source Data Providers 2009…..…………………………………
11
Abbreviations………………………………………………………………………………
14
List of Tables……………………………………………………………………………….
15
List of Figures………………………………………………………………………………
16
Introduction………………………………………………………………………………..
17
Results
Section A
General Information……………………………………………………
19
Section B
Patient Characteristics…………………………………………………
24
Section C
Interventions……………………………………………………………
40
Section D
Complications………………………………………………………….
48
Section E
Mortality Outcomes…………………………………………………...
57
Summary
64
References
4
REPORT SUMMARY
This is the report on all intensive care admissions to the 31 participating centres from 1
January to 31 December 2009.
The following are the main findings:
1.
The total number of ICU beds in the 31 participating units was 330 with a bed
occupancy rate of 87%.
2.
The number of cases analysed was 21226, an increase of 12% over the previous
year.
3.
The overall reporting rate had been fairly constant at 89%.
4.
The percentage of patients denied admission due to the unavailability of ICU
beds had declined from 56.5% to 40.0% in the last four years.
5.
The average age of the patients, excluding those below 18 years, was 50.3 years.
6.
The average lengths of ICU and hospital stay were 4.4 and 14.4 days
respectively.
7.
In MOH hospitals, 62% of ICU admissions were non-operative patients.
8.
Direct admissions to ICU from the emergency department had increased from
9% in 2004 to 21% in 2009.
9.
62% of ICU admissions had one or more organ failure within 24 hours of
admission.
10.
Head injury, sepsis and community-acquired pneumonia were the three most
common diagnoses leading to ICU admission in MOH hospitals. This trend
had remained the same over the past 7 years. The in-hospital mortality rates for
this group of patients were 27.0%, 62.2% and 46.3% respectively.
11.
The average SAPS II score was 35.8, which carries a predicted risk of inhospital mortality of 28.0%.
12.
In MOH hospitals, 79.3% of patients received invasive ventilation with an
average duration of 4.3 days.
13.
The percentage of patients who received non-invasive ventilation increased
from 6.5% in 2003 to 13.3% in 2009.
14.
The incidence of VAP decreased by more than half, from 28.0 to 11.6 per 1000
ventilator days, in the last seven years.
15.
The crude in-ICU and in-hospital mortality rates were 21.2% and 29.7%
respectively.
16.
The mean standardised mortality ratio was 0.89, (95% C.I. 0.86 – 0.91).
5
ACKNOWLEDGEMENT
The Malaysian Registry of Intensive Care would like to thank the following:
All site investigators and source data providers
The heads of Department of Anaesthesia and Intensive Care of participating ICUs
Staff of the participating ICUs
Quality of Health Care Section, Medical Development Division, Ministry of Health
Clinical Research Centre, Ministry of Health
and
All who have contributed in one way or another to MRIC
6
FOREWORD
This is the 7th report of the intensive care database started in 2002, under the ambit of
National Audit of Adult Intensive Care Units (NAICU). Although there has been a restructuring of the organisation and even a name change (now called Malaysian
Registry of Intensive Care, MRIC), the activity of auditing the intensive care practice in
Ministry of Health hospitals has continued to grow and this report is the culmination
of that effort.
In the last two years, MRIC had faced uncertainties in funding and technical support.
Thankfully the problem has been resolved. The Malaysian Society of Intensive Care
(MSIC) is now the main sponsor of the activity while the Clinical Research Centre
(CRC) provides the backend server support and the Quality Unit, Medical
Development Division, the administrative assistance. This arrangement will
undoubtedly provide a conducive environment for future development.
I would like to express my utmost appreciation to my colleagues in the National
Technical Committee under the leadership of Dr. Jenny Tong, for their commitment
and hard work during this trying period. Not only has the MRIC persevered, it has
achieved remarkable success in migrating the electronic records from stand-alone
units to a web-based programme. In these seven years, the number of centres recruited
had grown from 14 to 31; the number of intensive care beds studied from 100 to 330
and the number of patients analysed from 7,000 to 22,000. This two to three-fold
increase is testament of the strength and success of MRIC.
Clinicians’ support has been, and will remain, essential to the future of the registry.
Ultimately, the purpose of the registry is to improve quality of care. The Anaesthetic
and Intensive Care Service in Ministry of Health, with the support of the
administrators and health managers has achieved improvement in access and patient
outcome. The percentage of patients denied ICU admission and the incidence of
ventilator-associated pneumonia have declined over the years. In the coming year, the
focus will be on other quality improvement activities such as central venous catheter
care bundle and skin care bundle. I am confident that similar trends in improving
patient safety will continue.
Dr Ng Siew Hian
National Advisor
Anaesthetic and Intensive Care Service
Ministry of Health
7
TECHNICAL COMMITTEE
MALAYSIAN REGISTRY OF INTENSIVE CARE 2009
Advisor
Dr. Hjh Kalsom Maskon
Deputy Director (Quality of Health Care Section)
Medical Development Division, Ministry of Health
Dr. Ng Siew Hian
Consultant Anaesthesiologist and Head
Department of Anaesthesia and Intensive Care
Hospital Kuala Lumpur
Principal Investigator
Dr. Jenny Tong May Geok
Consultant Anaesthesiologist and Head
Department of Anaesthesia and Intensive Care
Hospital Tuanku Ja’afar Seremban
Co-Investigators
Dr. Tai Li Ling
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Kuala Lumpur
Dr. Tan Cheng Cheng
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Sultanah Aminah Johor Bahru
Dr. As-niza Abdul Shukor
Consultant Anaesthesiologist and Head
Department of Anaesthesia and Intensive Care
Hospital Taiping
Dr. Ahmad Shaltut Othman
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Sultanah Bahiyah Alor Setar
Dr. Lim Chew Har
Consultant Intensivist
Department of Anaesthesia and Intensive Care
Hospital Pulau Pinang
Medical Development
Division,
Ministry of Health
Dr. Paa Nasir Abdul Rahman
Principal Assistant Director
Dr. Fakhruddin Amran
Assistant Director
Puan Nor Wati Mohd
8
PARTICIPATING HOSPITALS
No.
Name of hospital
Abbreviation
Sites since 2002
1.
Hospital Sultanah Bahiyah Alor Setar
AS
2.
Hospital Pulau Pinang
PP
3.
Hospital Raja Permaisuri Bainun Ipoh
IPH
4.
Hospital Kuala Lumpur
KL
5.
Hospital Selayang
SLG
6.
Hospital Tengku Ampuan Rahimah Klang
KLG
7.
Hospital Tuanku Ja’afar Seremban
SBN
8.
Hospital Melaka
MLK
9.
Hospital Sultanah Aminah Johor Bahru
JB
10.
Hospital Tengku Ampuan Afzan Kuantan
KTN
11.
Hospital Sultanah Nur Zahirah Kuala Terengganu
KT
12.
Hospital Raja Perempuan Zainab II Kota Bharu
KB
13.
Hospital Umum Sarawak Kuching
KCH
14.
Hospital Queen Elizabeth Kota Kinabalu
KK
Sites since 2005
15.
Hospital Sultan Abdul Halim Sungai Petani
SP
16.
Hospital Putrajaya
PJY
17.
Hospital Pakar Sultanah Fatimah Muar
MUR
18.
Hospital Teluk Intan
TI
19.
Hospital Taiping
TPG
20.
Hospital Seberang Jaya
SJ
21.
Hospital Kajang
KJG
22.
Hospital Tuanku Fauziah Kangar
KGR
Sites since 2006
23.
Sime Darby Medical Centre Subang Jaya
SDMC
24.
Hospital Sultan Haji Ahmad Shah Temerloh
TML
25.
Hospital Tuanku Ampuan Najihah Kuala Pilah
KP
26.
Hospital Sri Manjung
SMJ
27.
Hospital Batu Pahat
BP
28.
Hospital Tawau
TW
29.
Hospital Miri
MRI
30.
Hospital Kulim
KLM
31.
Hospital Serdang
SDG
9
CATEGORIES OF ICU
Based on the number of ICU beds (for the purpose of MRIC 2009 report)
Participating sites with 12 ICU beds or more (as of 30th June 2009)
1.
Hospital Sultanah Bahiyah Alor Setar
2.
Hospital Raja Permaisuri Bainun Ipoh
3.
Hospital Taiping
4.
Hospital Kuala Lumpur
5.
Hospital Selayang
6.
Hospital Tengku Ampuan Rahimah Klang
7.
Hospital Melaka
8.
Hospital Sultanah Aminah Johor Bahru
9.
Hospital Sultanah Nur Zahirah Kuala Terengganu
10.
Hospital Raja Perempuan Zainab II Kota Bharu
Participating sites with less than 12 ICU beds (as of 30th June 2009)
11.
Hospital Tuanku Fauziah Kangar
12.
Hospital Pulau Pinang
13
Hospital Tengku Ampuan Afzan Kuantan
14.
Hospital Tuanku Ja’afar Seremban
15.
Hospital Umum Sarawak Kuching
16.
Hospital Queen Elizabeth Kota Kinabalu
17.
Hospital Seberang Jaya
18.
Hospital Sultan Abdul Halim Sungai Petani
19.
Hospital Teluk Intan
20.
Hospital Kajang
21.
Hospital Pakar Sultanah Fatimah Muar
22.
Hospital Putrajaya
23.
Hospital Serdang
24.
Hospital Sultan Haji Ahmad Shah Temerloh
25.
Hospital Tuanku Ampuan Najihah Kuala Pilah
26.
Hospital Sri Manjung
27.
Hospital Batu Pahat
28.
Hospital Tawau
29.
Hospital Miri
30.
Hospital Kulim
Private hospital
31.
Sime Darby Medical Centre Subang Jaya
10
LIST OF SITE INVESTIGATORS AND SOURCE DATA COLLECTORS
January – December 2009
No
Hospital
Site investigator
Data collectors
1
Sultanah Bahiyah Alor
Setar
Dr Ahmad Shaltut
Othman
SN Azura bte Che Don (Jan-Sept
2009)
SN Mazni bte Abas (Jan-Sept 2009)
SN Hafisoh Ahmad (Oct-Dec 2009)
SN Haslina Khalid (Oct-Dec 2009)
Sr Teoh Shook Lian
SN Seniwati bt Salleh
2
Pulau Pinang
Dr Lim Chew Har
SN Khairulniza bt Razar
SN Rosmalizawati bt Ibrahim
SN Siti Hazlina bt Bidin
3
Raja Permaisuri Bainun
Ipoh
Dr Azlina Muhamad
SN Khairiah bt Mat Daud
SN Saadiah bt Bidin
4
Kuala Lumpur
Dr Tai Li Ling
SN Prema Chitrasenan
SN Alice Nesamany Thangapandi
(Jan-Sept 2009)
5
Selayang
Dr Haslinda Abd Hashim
(Jan-Oct 2009)
Dr Laila Kamariah
(Oct-Dec 2009)
SN Norzaila bte Saad
SN Noor Azawati bt Daud
6
Tengku Ampuan
Rahimah Klang
Dr Faezah bt Shaari
SN Latifah bt Omar
SN Norlaili bt Ismail
7
Tuanku Ja’afar Seremban
Dr Jenny Tong May Geok
Sr Chew Bee Ngoh
SN Farawahida bt Ahmad
8
Melaka
Dr Anita Alias
SN Morni bt Omar
9
Sultanah Aminah Johor
Bahru
Dr Tan Cheng Cheng
SN Aisah bt Abu Bakar
AMO Mohd Zakuan bin Mohd Nor
AMO Anuar bin Ismail
AMO Hairizam bin Zulkhifli
10
Tengku Ampuan Afzan
Kuantan
Dr Rusnah bte Ab.
Rahman
SN Aminah bte Abd Hamid
Sr Noorhani bt Kassim
11
Sultanah Nur Zahirah
Kuala Terengganu
Dr Mohd Ridhwan bin
Mohd Nor
SN Zauwiah bt Idris
SN Norhayati bt Abd Rosman
12
Raja Perempuan Zainab
II Kota Bharu
Dr Mat Ariffin Saman
(Jan-Oct 2009)
Dr Wan Nasrudin bin
Wan Ismail
(Oct-Dec 2009)
SN Azilah bt Ishak
SN SN Azizum bt Ismail
SN Haryati bt Hassan
11
13
Umum Sarawak Kuching
Dr Intan Zarina bt Fakir
SN Norelsa bt Daim
SN Sabia Lew
SN Rosmica Jiton
14
Queen Elizabeth Kota
Kinabalu
Dr Khoo Tien Meng
SN Doren Abel (Jan-Oct 2009)
SN Jusim Lugu
SN Conny Chong Chiew Fah (OctDec 2009)
15
Sultan Abdul Halim
Sungai Petani
Dr Ahmad Zaini b Mohd
Salleh
SN Halijah Hasim
SN Rafiza Md Zuki
Sr Puziah bt Yahya
16
Putrajaya
Dr Fauziah bt Yusoff
SN Noryasni bt Mahtrod @Ahamed
SN Latifah bt Mohd Korib
Sr Noorainee bt Romi
17
Pakar Sultanah Fatimah
Muar
Dr Yogabigai
Balasundram
SN Ropeah bt Ahmad
SN Roslina bt Othman
18
Teluk Intan
Dr Khairudin bin Zainal
Abidin
(Jan-Dec 2009)
Dr Wang Shir Siong
(Dec 2009)
SN Azliza bt Zakaria
SN Rohayu Dalila bt Yusof
AMO Mohd Najib bin Misbah
19
Taiping
Dr As-niza Abdul Shukor
SN Umi Khatijah bt Bani
SN Saleha bt Salleh
20
Seberang Jaya
Dr Jainisda bt Zainuddin
SN Zuraina bt Muhamad
SN Nooraslina bt Othman
SN Noorazleena bt Hasim
21
Kajang
Dr Wan Hafizah bt Wan
Tajul Ariffin
SN Faiza bt Mat Yusof
22
Tuanku Fauziah Kangar
Dr Azilah bt Desa
SN Zarina Mat Bistaman
SN Julaida bt Din
SN Zulminarni bt Ariffin
23
Sime Darby Medical
Center Subang jaya
Dr Alan Wong Ket Hiung
SN Navjeet Kaur
SN Normazimah bt Mohamad Nazar
24
Sultan Haji Ahmad Shah
Temerloh
Dr.Rahimah bt Haron
SN Rakiah bt Mohd Noor
SN Zaiton bt Isa
25
Tuanku Ampuan Najihah
Kuala Pilah
Dr.Sharuddin bin Musa
(Jan-May 2009)
Dr Zalifah bt Nordin
(May-Dec 2009)
SN Noormaisah bt Mohd Derus (JanMay 2009)
SN Noorliza bt Othman (May-Dec
2009)
Sr Lee New
12
26
Sri Manjung
Dr.Tin Tin Myint
Sr Rohana Ali
SN Hartini A.Rahman
27
Batu Pahat
Dr.Azmiza bt Mahani
(Jan-July 2009)
Dr Azizul Hisham b
Bahari (July-Dec 2009)
SN Zaidah bt Othman (Jan-Aug 2009)
SN Rosmawati bt Saimin
28
Tawau
Dr.Kyaw Soe
SN Lilybeth Feliciano Perez
SN Sarwah bt Isa
29
Miri
Dr Noorhafizah bt
Ghazali
SN Norlida bt Daud
SN Zurina bt Achim
30
Kulim
Dr.Chua Kok Boon
Dr Loh Hoong Heng
SN Mohana bt Omar
SN Bahayah bt Mohamed Bakairi
Sr Mahani bt Hassan
31
Serdang
Dr.Mohd Yani Bahari
SN Zamzurina bt Jahaya
SN Norain bt Mohd Saad
SN Siti Ainah bt Buang
13
ABBREVIATIONS
Adm.
Admission
AMO
Assistant medical officer
AOR
At own risk
APACHE II
Acute Physiologic and Chronic Health Evaluation (Version II)
CRRT
Continuous renal replacement therapy
ED
Emergency department
ENT
Otorhinolaryngology
HD
Haemodialysis
HDU
High dependency unit
Hosp
Hospital
ICU
Intensive care unit
Int.
Intensive
MOH
Ministry of Health
MRIC
Malaysian Registry of Intensive Care
MV
Mechanical ventilation
NA
Not available
NAICU
National Audit on Adult Intensive Care Units
NIV
Non-invasive ventilation
NHSN
National Healthcare Safety Network
NNIS
National Nosocomial Infection Surveillance
No.
Number
O&G
Obstetrics & Gynaecology
Refer.
Referred
SAPS II
Simplified Acute Physiologic Scoring System (Version II)
SD
Standard deviation
SMR
Standardised mortality ratio
SN
Staff nurse
SOFA
Sequential Organ Failure Assessment
Sr
Sister
SPSS
Statistical Package for Social Sciences
VAP
Ventilator-associated pneumonia
VCB
Ventilator care bundle
Yrs
Years
%
Percentage
14
LIST OF TABLES
Page
19
20
22
Table 1
Table 2
Table 3
Table 4
ICU beds and ICU bed occupancy rate, by MOH hospitals 2007-2009……………..
ICU admissions, by individual hospital 2004 – 2009…………………………………
Reporting rates, by individual hospital 2007 – 2009………………………………….
Intensive care referrals and refusal of admission, by individual hospital 2004 –
2009………………………………………………………………………………………...
Table 5
Table 6
Table 7
Table 8
Table 9
Table 10
Table 11
Table 12
Table 13
Table 14
Table 15
Table 16
Table 17
Table 18
Table 19
Gender 2004-2009………………………………………………………………………...
Mean age 2004-2009……………………………………………………………………..
Ethnic groups 2009……………………………………………………………………….
Length of ICU stay, by individual hospital 2004 – 2009……………………………...
Length of hospital stay, by individual hospital 2004 – 2009…………………………
Referring units 2009 ……………………………………………………………………..
Category of patients 2009……………………………………………….……………….
Category of patients in MOH hospitals 2004-2009 …………………………………...
Location before ICU admission, by hospitals 2009…………………………………...
Location before ICU admission in MOH hospitals 2004 – 2009…………………….
Indication for ICU admission 2009 …………………………………….……………....
Main organ failure on ICU admission 2009 ………………………….………………..
Number of organ failure(s) on ICU admission 200……………………………………
Ten most common diagnoses leading to ICU admission 2009 ……………………...
Ten most common diagnoses leading to ICU admission using APACHE II
diagnostic category 2009 ……………………………………………………………….
SAPS II score, by individual hospital 2003 – 2009 ……………………………………
SOFA score, by individual hospital 2007 – 2009 ……………………………………...
Invasive ventilation, non-invasive ventilation and reintubation 2009 ……………..
Duration of invasive ventilation, by individual hospital 2005 – 2009 …………………
Renal replacement therapy and modalities of therapy 2009………………………...
Tracheostomy 2009 …………………………………..………………………………….
Tracheotomy, by individual hospital 2009…………………………………………….
Tracheostomy, by individual hospital 2006-2009……………………………………..
Withdrawal /withholding of therapy, by individual hospital 2008-2009………….
Incidence of ventilator-associated pneumonia, by individual hospital 2003 –2009…
Onset of VAP from initiation of invasive ventilation, by individual hospital 2007
2009………………………………………………………………………………………….
Bacteriological cultures in VAP 2009 ………………………………………………….
Bacteriological cultures in VAP 2007 – 2009…………………………………………….
Unplanned extubation per 100 intubated days, by individual hospital 2003 – 2009…
Pressure ulcer, by individual hospital 2009 ……………………………………………
Hospital outcome 2009 ……………………………………………………………………
Crude in-ICU and in-hospital mortality rates, by individual hospital 2004 – 2009
Ten most common diagnoses leading to ICU admission and observed in-hospital
mortality in MOH hospitals 2009………………………………………………………
Interventions, complications and observed in-hospital mortality 2009…………….
Standardised mortality ratio by individual hospital 2004-2009……………………..
Table 20
Table 21
Table 22
Table 23
Table 24
Table 25
Table 26
Table 27
Table 28
Table 29
Table 30
Table 31
Table 32
Table 33
Table 34
Table 35
Table 36
Table 37
Table 38
Table 39
15
23
24
24
26
26
27
28
29
30
31
31
32
33
34
35
37
38
39
40
42
43
44
45
46
47
48
49
52
52
54
56
57
58
61
61
62
LIST OF FIGURES
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
ICU admissions, by participating centres 2009 …………………………………
ICU admissions 2003 – 2009…………………………………………………….
Age groups 2009 ………………………………………………………………...
Ethnic groups 2009 ……………………………………………………………...
Referring units 2009 ……………………………………………………………
Category of patients 2009 ………………………………………………………
Category of patients 2004 – 2009……………………………………………….
Location before ICU admission, by hospitals 2009 …………………………
Indication for ICU admission 2009 ……………………………………………
Main organ failure on ICU admission, by hospitals 2009 …………………...
Number of organ failure(s) on ICU admission, by hospitals 2009 ……………
Ten most common diagnoses leading to ICU admission in MOH hospitals
2009………………………………………………………………………………
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Figure 23
Figure 24
Figure 25
Figure 26
Figure 27
Figure 28
Figure 29
Invasive ventilation, by hospitals 2009 ………………………………………
Non-invasive ventilation, by hospitals 2009 …………………………………
Non-invasive ventilation, MOH hospitals 2003 – 2009 ……………………..
Re-intubation, MOH hospitals 2003 – 2009…………………………………..
Modalities of renal replacement therapy, by hospitals 2009 ………………
Techniques of tracheostomy, by hospitals 2009 ……………………………
VAP per 1000 ventilator days 2003 - 2009 …………………………………….
VAP per 1000 ventilator days, by individual hospital 2009………………..
VCB compliance and VAP 2007 – 2009………………………………………..
Bacteriological cultures in VAP 2009 …………………………………………
Unplanned extubation, by individual hospital 2009………………………..
Crude in-ICU and in-hospital mortality rates, by individual hospital 2009
Number of organ failure and mortality 2009 ………………………………..
SOFA score and observed in-hospital mortality 2009 ………………………
Category of patients and observed in-hospital mortality 2009……………..
Main organ failure and observed in-hospital mortality 2009 ………………
Standardised mortality ratio by individual hospital 2009…………………...
Page
21
21
24
25
28
29
30
31
32
33
36
37
40
40
41
41
43
44
50
50
50
53
55
59
59
60
60
60
63
16
INTRODUCTION
The National Audit on Adult Intensive Care Units (NAICU) was established in 2002
as a quality improvement initiative to systematically review the intensive care
practices in Malaysia and where possible, to introduce remedial measures to
improve outcome. To date, this audit had published six reports and introduced
several quality measures such as ventilator care bundle, central venous care bundle
and ICU networking.
In 2009, the NAICU underwent a major re-organisation and was renamed the
Malaysian Registry of Intensive Care. This report is thus the second for MRIC, but
seventh in the series. Following the change, MRIC has now become a member of the
national registry under the purview of Clinical Research Centre, Ministry of Health.
The objectives of the MRIC are to:
1. Establish a database of patients admitted to the adult ICUs
2. Review the clinical practices of intensive care
3. Determine clinical outcome
4. Determine the resources and delivery of intensive care service
5. Evaluate the impact of quality improvement measures on patient care
6. Provide comparisons of performance of participating centres against national
and international standards
7. Conduct healthcare research related to intensive care
This report describes the intensive care practices and outcomes in an ICU in a private
hospital and 30 ICUs in MOH.
Data Collection and Verification
Data were collected prospectively in all 31 ICUs by trained nurses (source data
providers) and specialists (site investigators) based on a written protocol. Data
initially collected on a case report form for each patient was subsequently transferred
to a customised software called SyNapse.. At three monthly intervals, the data was
‘burned’ into compact discs and sent to the coordinating centre in Hospital Kuala
Lumpur for ‘data merging’.
All participating centres were to ensure “accuracy and completeness” of their
individual databases before being uploaded and sent to the coordinating centre.
Merged data were ‘cleaned’ and verified before being analysed using SPSS version
10.0.1.
17
This report is based on all admissions into the 31 participating ICUs from 1 January
to 31 December 2009. Those admitted during this period but were still in hospital on
31 January 2010, were excluded from the analysis. The total number of admissions in
2009 was 22,234, out of which 968 (4.4%) were readmissions. For patients with
multiple ICU admissions, only the first admission was included in the analysis.
Due to missing and inconsistent data, the sum total of some variables shown in the
tables may not add up to the actual number of admissions.
Data Limitations
Limitations to the registry data were mainly related to the data entry and collection
process. Some of the participating ICUs experienced rapid turnover of their site
investigators and source data providers resulting in data inconsistencies. Some
centres encountered problems in accessing their local electronic database due to
hardware problems. Due to logistical problems, the technical committee of the MRIC
was unable to verify missing and inconsistent data with the specific participating
centres and to perform site visits.
Format of Report
The format of this report follows the patient journey in four sections: demographics,
interventions, complications and outcomes. Information is reported on a total of
21,266 ICU admissions.
In this report, information was provided for individual centres. Wherever
appropriate, comparisons were made between categories of hospitals based on the
number of ICU beds. In MOH hospitals the categories were centres with 12 beds or
more and those with less than 12 beds. Where relevant, trends of certain variables
over the years were reported.
The Future
The year 2009 was the last, when electronic records were collected on respective
computers before being sent to the coordinating centre in Hospital Kuala Lumpur
for data merging. From 1 January 2010 onwards, data entry will be performed webbased using a standard e-case report form. Another 6 six new centres (Hospitals
Sungai Buloh, Ampang, Sultan Ismail Pandan, Sibu, Duchess of Kent Sandakan and
Hospital Wanita & Kanak-Kanak Sabah) will be added to the list of participating
hospitals in the MRIC.
18
SECTION A:
Table 1:
Hospital
GENERAL INFORMATION
ICU beds and ICU bed occupancy rate, by MOH hospitals 2007 2009
Number of functional
ICU beds (as of 31-12-2009)
ICU bed occupancy rate %
2007
2008
2009
AS
14
66.2
80.5
88.6
PP
14
113.7
94.0
81.3
IPH
16
71.1
79.1
103.0
KL
30
112.3
112.7
108.6
SLG
16
75.7
80.2
72.6
KLG
22
98.4
100.5
198.7
SBN
8
111.8
110.4
111.8
MLK
22
84.7
87.3
84.2
JB
16
111.5
106.7
115.1
KTN
10
89.5
89.5
102.2
KT
16
101.3
109.2
115.2
KB
12
88.5
88.9
86.6
KCH
9
108.0
96.8
101.5
KK
9
109.7
125.3
87.3
SP
7
85.5
90.8
79.3
PJY
9
108.8
89.2
88.4
MUR
7
63.5
108.2
72.6
TI
4
107.0
83.0
86.5
TPG
18
61.5
83.5
83.6
SJ
8
76.7
68.7
101.9
KJG
6
78.4
74.2
75.8
KGR
5
87.8
79.1
71.8
TML
10
98.9
133.8
119.0
KP
4
62.9
57.8
51.0
SMJ
7
101.3
121.9
71.6
BP
4
74.5
86.4
77.0
TW
6
64.2
64.5
45.9
MRI
6
83.0
87.9
54.5
KLM
7
98.6
98.2
121.2
SDG
8
86.1
116.0
102.0
Total
330
-
-
-
Mean
-
89.4
93.5
97.3
Median
-
88.1
89.3
87.0
19
Table 2:
ICU admissions, by individual hospital 2004 – 2009
2004
Hospital
2005
2006
2007
2008
2009
n (%)
n (%)
n (%)
n (%)
n (%)
n (%)
AS
320 (4.4)
340 (4.6)
383 (3.8)
418 (3.2)
546 (3.2)
1121 (5.3)
PP
518 (7.2)
488 (6.5)
535 (5.3)
439 (3.3)
568 (3.3)
505 (2.4)
IPH
379 (5.3)
335 (4.5)
692 (6.8)
723 (5.5)
873 (5.1)
924 (4.3)
KL
991 (13.7)
1158 (15.5)
942 (9.3)
943 (7.2)
1578 (9.3)
1768 (8.3)
SLG
432 (6.0)
580 (7.8)
692 (6.8)
738 (5.6)
877 (5.2)
888 (4.2)
KLG
327 (4.5)
399 (5.3)
491 (3.9)
482 (3.7)
788 (4.6)
1080 (5.1)
SBN
304 (4.2)
295 (3.9)
292 (2.9)
427 (3.2)
467 (2.7)
510 (2.4)
MLK
717 (9.9)
666 (8.9)
634 (6.3)
1175 (8.9)
1366 (8.0)
1439 (6.8)
1026 (14.2)
920 (12.3)
1018 (10.1)
1074 (8.2)
1106 (6.5)
1245 (5.9)
KTN
475 (6.6)
478 (6.4)
432 (4.3)
513 (3.9)
563 (3.3)
613 (2.9)
KT
338 (4.7)
361 (4.8)
417 (4.1)
270 (2.1)
601 (3.5)
824 (3.9)
KB
422 (5.8)
469 (6.3)
442 (4.4)
725 (5.5)
847 (5.0)
803 (3.8)
KCH
503 (7.0)
528 (7.1)
594 (5.9)
461 (3.5)
464 (2.7)
461 (2.2)
KK
467 (6.5)
455 (6.1)
454 (4.5)
517 (3.9)
687 (4.0)
319 (1.5)
SP
-
-
202 (2.0)
119 (0.9)
183 (1.1)
261 (1.2)
PJY
-
-
234 (2.3)
NA
351 (2.1)
397 (1.9)
MUR
-
-
328 (3.2)
611 (4.6)
869 (5.1)
774 (3.6)
TI
-
-
318 (3.1)
253 (1.9)
281 (1.7)
262 (1.2)
TPG
-
-
259 (2.0)
684 (5.2)
412 (2.4)
867 (4.1)
SJ
-
-
412 (4.1)
59 (0.4)
504 (3.0)
599 (2.8)
KJG
-
-
228 (2.3)
146 (1.1)
142 (0.8)
265 (1.2)
KGR
-
-
211 (2.1)
238 (1.8)
268 (1.6)
302 (1.4)
SDMC
-
-
-
1842 (12.2)
1900 (10.0)
2085 (9.8)
TML
-
-
-
382 (2.9)
429 (2.5)
607 (2.9)
KP
-
-
-
140 (1.1)
193 (1.1)
165 (0.8)
SMJ
-
-
-
226 (1.70
347 (2.0)
336 (1.6)
BP
-
-
-
266 (2.0)
342 (2.0)
397 (1.9)
TW
-
-
-
256 (1.9)
316 (1.9)
215 (1.0)
MRI
-
-
-
180 (1.4)
267 (1.6)
212 (1.00
KLM
-
-
-
298 (2.3)
316 (1.9)
343 (1.6)
SDG
-
-
-
385 (2.9)
456 (2.7)
679 (3.2)
7219 (100)
7472 (100)
10110 (100)
14990 (100)
18907 (100)
21266 (100)
JB
Total
The number of admissions has increased over the years. The increase from 2008 to
2009 was about 12%. There was an increase in number of admissions in most centres.
Hospital AS and Hospital TPG had increases of more than 100% in admissions
compared to the previous year. This was attributed to expansion of their ICUs in 2009.
20
Figure 1:
Figure 2:
ICU admissions, by participating centres 2009
ICU admissions, 2003 - 2009
21
Table 3:
Reporting rates, by individual hospital 2007 – 2009
Hospital
2007
%
2008
%
2009
%
AS
86.7
91.3
93
PP
93.2
97.4
93
IPH
97.1
96.3
96
KL
98.4
98.9
95
SLG
99.2
99.7
84
KLG
99.4
90.9
92
SBN
97.7
99.6
97
MLK
99.9
99.3
92
JB
99.5
99.8
97
KTN
99.4
99.6
96
KT
49.6
98.2
90
KB
100.0
99.3
94
KCH
93.0
93.0
89
KK
75.2
90.3
60
SP
29.2
53.4
50
PJY
0
80.9
87
MUR
74.3
82.6
80
TI
87.6
102.2
97
TPG
99.9
46.6
95
SJ
20.1
99.0
96
KJG
54.0
57.7
87
KGR
82.2
91.8
94
TML
95.7
95.8
86
KP
89.4
98.0
98
SMJ
92.5
89.2
100
BP
90.9
97.2
90
TW
90.3
100.0
93
MRI
82.9
68.5
65
KLM
98.1
101.3
97
SDG
97.5
98.9
94
Total
82.4
89.9
89.0
The reporting rate is calculated by comparing the number of ICU admissions
reported to the MRIC and to the national census (collected by Anaesthetic program
head). The total number reported to the MRIC was slightly less than that to the
national census, as patients who were still in hospital on 31 January 2010 were
excluded in the analysis.
Overall, there was an improvement in the reporting rates from 82.4% in 2007 to 89%
in 2009. However, Hospitals KK. SP and MRI had poor reporting rates.
22
Table 4:
Hosp
Intensive care referrals and refusal of admission, by individual
hospital 2004 - 2009
2004
2005
No.
refer.
for int.
care
%
denied
adm.
%
denied
adm.
No.
refer.
for int.
care
AS
224
37.9
#
#
#
PP
827
70.5
1024
73.2
1054
IPH
789
90.4
872
91.6
351
KL
1795
32.5
2170
38.0
SLG
290
51.7
#
KLG
387
55.6
SBN
984
MLK
2007
%
denied
adm.
2008
No.
refer.
for int.
care
%
denied
adm.
#
429
78.1
1299
94.3
2294
#
737
74.6
116
JB
2009
No.
refer.
for int.
care
%
denied
adm.
No.
refer.
for int.
care
%
denied
adm.
76.2
227
81.8
1478
23.4
358
19.0
84.3
1407
82.3
635
77.2
633
79.5
612
82.5
38.4
2327
36.2
2512
34.4
2230
31.0
185
45.9
79
16.5
440
40.0
345
33.6
73.8
876
74.5
1490
82.3
1657
73.0
2072
64.2
1048
69.8
1330
66.0
1558
62.6
1770
65.5
1863
63.3
31.9
811
50.7
879
52.2
1085
43.2
940
62.1
981
56.0
1524
61.4
870
68.5
2066
57.2
2101
48.6
1638
49.0
1111
50.1
KTN
467
KT
398
37.0
454
35.0
447
36.9
811
33.3
768
28.3
755
20.4
43.0
404
30.2
476
29.2
160
20.6
385
26.8
105
30.5
KB
812
52.2
908
50.7
720
57.9
953
68.1
1067
67.1
1219
66.1
KCH
544
32.2
535
29.7
315
30.5
569
51.5
580
61.4
486
58.4
KK
115
67.8
#
#
249
48.6
299
60.9
294
60.9
378
7.9
SP
-
-
-
-
#
#
95
60.9
137
42.3
48
18.8
PJY
-
-
-
-
#
#
#
#
212
#
#
#
MUR
-
-
-
-
#
#
575
18.1
542
32.1
#
#
TI
-
-
-
-
#
#
211
9.5
52
5.8
#
#
TPG
-
-
-
-
488
62.9
685
5.7
499
15.4
1186
11.6
SJ
-
-
-
-
#
#
226
1.3
222
21.6
660
15.0
KJG
-
-
-
-
#
#
9
22.2
#
#
#
#
KGR
-
-
-
-
#
#
84
19.1
335
20.3
165
22.4
TML
-
-
-
-
-
-
416
22.1
303
44.6
68
35.3
KP
-
-
-
-
-
-
225
26.7
334
39.2
346
48.6
SMJ
-
-
-
-
-
-
192
35.4
236
26.7
174
17.8
BP
-
-
-
-
-
-
310
14.8
346
4.3
442
7.0
TW
-
-
-
-
-
-
248
0.0
326
#
#
#
MRI
-
-
-
-
-
-
116
25.0
168
14.5
126
29.4
KLM
-
-
-
-
-
-
289
17.7
291
12.7
302
10.6
SDG
-
-
-
-
-
-
162
27.8
299
43.1
698
30.8
9272
54.5
9833
56.5
12280
18689
48.3
18365
40.0
Total
No.
refer.
for int.
care
2006
53.4
17638
47.9
# Missing data
The percentage of patients who was refused admission due to unavailability of ICU
beds in 2009 was 40%, a significant improvement from 56.5% in 2005. However, 8
hospitals had high refusal rates of more than 50%.
23
SECTION B:
PATIENT CHARACTERISTICS
Table 5:
Gender 2004 - 2009
Gender
2004
n (%)
2005
n (%)
2006
n (%)
2007
n (%)
2008
n (%)
2009
n (%)
Male
4150 (57.5)
4406 (59.0)
5821 (57.6)
7654 (58.2)
11081 (58.7)
12489 (58.7)
Female
3058 (42.4)
3066 (41.0)
4289 (41.0)
5492 (41.8)
7811 (41.3)
8768 (41.3)
Table 6:
Age
Mean age (years) 2004 - 2009
2004
2005
2006
2007
2008
2009
All ages,
Mean + SD yrs
40.9 ± 21.2
42.3 ± 21.0
43.3 ± 20.8
45.0 ± 21.0
46.5 ± 20.9
46.5 ± 20.9
Age ≥ 18 years
Mean + SD yrs
-
-
-
50.3 ± 18.2
50.3 ± 18.1
-
The average age for all age groups was 46.5 + 20.9 years (median 48.4 years). For
adult patients, with age exceeding 18 years, the average age was 50.3 + 18.2 years
(median 51.5 years). The average age of patients admitted to ICUs had increased
over the years.
Figure 3 :
Age groups, 20009
Geriatric patients (age more than 65 years) and paediatric patients (age less than 12 years)
accounted for 23.5% and 3.8% of total admissions respectively.
24
Table 7:
Ethnic groups 2009
Ethnic group
n
%
Malay
Chinese
Indian
Foreigner
Bumiputra Sabah/Sarawak
Other Malaysian
Orang Asli
Unknown
12339
4427
2361
1006
755
363
152
43
58.0
20.9
11.1
4.7
2.6
1.7
0.7
0.2
Total
21266
100
Figure 4:
Ethnic groups 2009
The distribution of patients admitted to ICU reflected the distribution of the ethnic
groups in the general population in Malaysia. Foreigners constituted about 4.7% of
the ICU population.
25
Table 8:
Length of ICU stay, by individual hospital 2004 – 2009
Mean (Median), days
Hospital
2004
2005
2006
2007
2008
2009
AS
3.9
4.0
4.3
4.3 (2.4)
4.3 (2.4)
3.9 (2.2)
PP
5.0
5.5
4.5
5.2 (2.2)
4.6 (2.0)
5.4 (2.5)
IPH
5.1
5.8
5.1
5.4 (2.7)
5.1 (2.7)
5.1 (2.8)
KL
5.4
4.7
5.2
5.1 (2.9)
4.9 (2.4)
4.9 (2.8)
SLG
5.8
5.1
4.6
4.5 (2.6)
4.4 (2.7)
4.4 (2.7)
KLG
6.5
5.3
4.9
4.4 (1.9)
4.8 (2.7)
4.9 (2.7)
SBN
4.7
4.8
5.4
4.8 (3.0)
5.9 (3.0)
5.3 (2.9)
MLK
2.7
2.8
2.8
3.7 (1.9)
4.0 (2.0)
4.3 (2.1)
JB
5.2
5.9
4.8
4.9 (2.5)
4.9 (3.8)
4.5 (2.4)
KTN
3.9
3.9
4.2
4.2 (2.3)
4.8 (2.5)
4.7 (2.9)
KT
4.1
3.9
3.5
4.3 (2.3)
4.2 (2.6)
4.3 (2.7)
KB
5.4
4.6
4.5
4.8 (2.5)
4.5 (2.5)
4.4 (2.3)
KCH
3.8
3.4
3.3
4.7 (2.3)
5.5 (2.6)
5.4 (2.7)
KK
4.5
4.7
5.0
4.6 (2.3)
4.6 (2.0)
5.4 (2.9)
SP
-
-
5.1
6.4 (4.1)
7.3 (4.8)
3.9 (2.4)
PJY
-
-
-
-
4.5 (1.9)
4.4 (1.9)
MUR
-
-
5.7
5.1 (2.8)
4.4 (3.0)
4.4 (2.0)
TI
-
-
3.9
4.4 (2.5)
3.7 (2.4)
3.5 (2.1)
TPG
-
-
4.3
4.8 (2.5)
4.5 (2.8)
5.4 (2.7)
SJ
-
-
4.6
5.9 (1.9)
5.5 (2.5)
4.3 (2.6)
KJG
-
-
4.5
4.4 (2.7)
4.6 (2.5)
4.9 (2.6)
KGR
-
-
3.5
5.2 (2.1)
5.2 (2.8)
4.0 (2.7)
SDMC
-
-
-
2.5 (1.2)
2.5 (1.4)
2.3 (1.2)
TML
-
-
-
4.4 (2.2)
4.8 (2.7)
5.0 (2.8)
KP
-
-
-
5.4 (2.2)
4.2 (2.4)
4.9 (2.4)
SMJ
-
-
-
6.4 (2.5)
4.9 (2.7)
5.3 (3.0)
BP
-
-
-
5.5 (2.7)
5.6 (3.2)
4.3 (2.5)
TW
-
-
-
4.0 (2.3)
4.4 (2.0)
4.2 (2.2)
MRI
-
-
-
5.5 (3.1)
4.8 (2.8)
6.2 (3.0)
KLM
-
-
-
3.5 (2.2)
3.6 (2.4)
4.2 (2.6)
SDG
-
-
-
4.6 (2.10
4.5 (2.3)
4.3 (2.1)
4.7
4.6
4.5
4.7 (2.4)
4.7 (2.6)
4.4 (2.3)
Total
The mean length of ICU stay was 4.4 days and it had decreased compared with previous
years. SDMC recorded the shortest length of stay (2.3 days) while Hospital MRI reported the
longest stay of 6.2 days.
26
Table 9:
Length of hospital stay, by individual hospital 2004 – 2009
Mean (Median), days
Hospital
2004
2005
2006
2007
2008
2009
AS
16.8
14.9
14.8
14.2 (9.7)
15.5 (9.3)
12.6 (7.9)
PP
24.3
22.1
20.3
21.7 (14.0)
21.4 (13.7)
20.4 (11.5)
IPH
19.8
19.0
16.6
15.4 (10.6)
17.0 (10.6)
14.5 (10.0)
KL
22.9
18.7
19.6
19.7 (12.4)
20.1 (11.4)
18.5 (10.8)
SLG
20.3
17.6
17.1
17.2 (10.7)
16.9 (11.1)
17.1 (10.2)
KLG
19.2
17.0
15.9
15.7 (10.8)
18.8 (11.3)
15.5 (10.8)
SBN
16.7
15.8
17.1
16.6 (11.1)
20.4 (12.4)
16.0 (10.8)
MLK
15.0
14.0
12.5
13.6 (9.7)
14.6 (10.0)
13.6 (8.9)
JB
17.7
17.9
15.7
16.2 (11.3)
16.1 (10.4)
14.9 (10.0)
KTN
18.9
16.5
16.0
17.5 (12.1)
18.5 (12.4)
15.3 (10.9)
KT
16.6
14.4
16.1
15.2 (9.0)
16.7 (11.9)
13.2 (8.7)
KB
17.8
15.7
16.1
16.4 (10.7)
16.0 (10.9)
17.2 (10.7)
KCH
21.2
17.4
17.7
20.4 (13.1)
21.2 (14.1)
19.8 (12.8)
KK
22.8
22.8
23.3
29.5(19.0)
26.2 (15.2)
23.2 (14.9)
SP
-
-
14.0
11.4 (7.6)
14.4 (9.6)
10.5 (7.9)
PJY
-
-
-
-
13.8 (7.9)
13.5 (8.3)
MUR
-
-
17.9
15.7 (10.5)
17.6 (10.3)
15.8(10.2)
TI
-
-
12.3
10.8 (8.03)
11.7 (8.5)
11.6 (7.6)
TPG
-
-
15.6
12.0 (8.3)
11.6 (7.9)
12.5 (8.3)
SJ
-
-
10.7
14.5 (8.4)
12.9 (9.1)
11.0 (8.7)
KJG
-
-
13.3
13.9 (10.3)
12.6 (9.8)
13.8 (9.2)
KGR
-
-
14.5
18.1 (10.4)
15.6 (10.7)
16.3 (10.7)
SDMC
-
-
-
12.1 (5.7)
11.8 (5.9)
8.4 (5.1)
TML
-
-
-
13.9 (9.8)
15.5 (11.2)
14.0(10.4)
KP
-
-
-
13.8 (7.6)
11.3 (8.6)
12.9 (8.6)
SMJ
-
-
-
13.5 (9.0)
10.6 (6.8)
11.4(7.9)
BP
-
-
-
13.0 (7.7)
14.8 (9.9)
12.0 (8.4)
TW
-
-
-
12.4 (8.9)
15.8 (9.7)
13.3 (7.9)
MRI
-
-
-
15.2 (10.3)
14.6 (10.0)
15.1 (9.9)
KLM
-
-
-
11.4 (7.2)
10.3 (7.7)
10.8 (7.8)
SDG
-
-
-
16.6 (10.4)
17.1 (9.6)
15.8 (9.3)
19.5
17.6
16.4
16.3 (10.5)
15.9 (10.3)
14.4 (9.0)
Total
The average length of hospital stay had decreased over the years from 19.5 days in 2004 to
14.4 days in 2009. Hospital KK reported an average length of hospital stay that exceeded 20
days.
27
Table 10:
Referring units 2009
Hospitals
Referring units
Beds ≥ 12
n(%)
Beds < 12
n(%)
Private
n(%)
Total
n(%)
Medicine
4733 (43.2)
3475 (42.5)
720 (34.6)
8928 (42.1)
General Surgery
2876 (26.3)
2560 (31.3)
138 (6.6)
5574 (26.3)
832 (7.6)
678 (8.3)
169 (8.1)
1679 (7.9)
734 (6.7)
531 (6.5)
29 (1.4)
1294 (6.1)
141 (1.3)
12 (0.1)
30 (1.4)
183 (0.9)
Orthopaedic Surgery
O&G
Vascular Surgery
Paediatric Surgery
52 (0.5)
58 (0.7)
9 (0.4)
119 (0.6)
Neurosurgery
601 (5.5)
271 (3.3)
193 (9.3)
1065 (5.0)
Plastic surgery
52 (0.5)
38 (0.5)
10 (0.5)
100 (0.5)
ENT
205 (1.9)
156 (1.9)
68 (3.3)
429 (2.0)
Ophthalmology
14 (0.1)
10 (0.1)
2 (0.1)
26 (0.1)
Urology
107 (1.0)
38 (0.5)
56 (2.7)
201 (0.9)
Dental Surgery
85 (0.8)
35 (0.4)
2 (0.1)
122 (0.6)
Paediatric Medical
135 (1.2)
211 (2.6)
92 (4.4)
438 (2.1)
7 (0.1)
11 (0.1)
205 (9.8)
223 (1.1)
Cardiology
Haematology
3 (0.0)
8 (0.1)
19 (0.9)
30 (0.1)
Nephrology
151 (1.4)
60 (0.7)
84 (4.0)
295 (1.4)
Neurology
111 (1.0)
10 (0.1)
244 (11.7)
365 (1.7)
-
2 (0.0)
4 (0.2)
6 (0.0)
Cardiothoracic Surgery
Others
108 (1.0)
16 (0.2)
8 (0.4)
132 (0.6)
Total
10947 (100)
8180 (100)
2082 (100)
21209 (100)
Figure 5:
Referring units 2009
The proportion of patients admitted from the medical-based disciplines had steadily
increased from 29.5% in 2003 to 46.4% in 2009.
28
Table 11:
Category of patients 2009
Hospitals
Category of patients
Beds ≥ 12
n (%)
Beds < 12
n (%)
Private
n (%)
Total
Non-operative
6656 (60.8)
4953 (60.4)
1488 (71.5)
13097 (61.7)
Elective operative
1238 (11.3)
1020 (12.4)
466 (22.4)
2724 (12.8)
Emergency operative
3055 (27.9)
2226 (27.1)
128 (6.1)
5409 (25.5)
10949 (100)
8199 (100)
2082 (100)
21230 (100)
Total
Non-operative;
Operative elective:
Operative-emergency:
Figure 6:
Refers to patients in whom no surgery was done out within 7 days before ICU admission or
during the first 24 hours after ICU admission
Refers to patients in whom surgery was done within 7 days before ICU admission or during the
first 24 hours after ICU admission on a scheduled basis
Refers to patients in whom surgery was done within 7 days before ICU admission or during the
first 24 hours after ICU admission on an unscheduled basis
Category of patients 2009
The categories of patients did not differ between ICUs in MOH hospitals. However,
the proportion of emergency operative patients in the private hospital was
significantly less compared to MOH hospitals.
29
Table 12:
Category of patients in MOH hospitals 2004 - 2009
Category of patients
2004
(%)
2005
(%)
2006
(%)
2007
(%)
2008
(%)
2009
(%)
Non-operative
44.8
48.4
49.0
55.8
59.2
61.6
Elective operative
18.8
16.5
15.9
13.2
14.3
12.8
Emergency operative
34.4
35.1
35.1
31.0
26.5
25.4
Figure 7:
Category of patients 2004 - 2009
There was a steady increase in non-operative patients over the past 6 years with a
17% increase from 2004 to 2009. Correspondingly, the percentage of elective
operative and emergency operative patients decreased by 6% and 9% respectively
from 2004 to 2009.
30
Table 13:
Location before ICU admission, by hospitals 2009
Location
Beds ≥ 12
n (%)
Hospitals
Beds < 12
n (%)
Private
n (%)
Total
n (%)
Ward
3789 (34.6)
3393 (41.4)
496 (23.8)
7678 (36.2)
OT
3473 (31.7)
2550 (31.1)
441 (21.2)
6464 (30.5)
A&E
2471 (22.6)
1455 (17.8)
991 (47.6)
4917 (23.2)
Other critical area
549 (5.0)
285 (3.5)
5 (0.2)
839 (4.0)
Other location
83 (0.8)
46 (0.6)
110 (5.3)
239 (1.1)
Other hospital
583 (5.3)
462 (5.6)
39 (1.9)
1084 (5.1)
10948 (100.0)
8191 (100.0)
2082 (100.0)
21221 (100.0)
Total
Figure 8:
Location before ICU admission, by hospitals 2009
Table 14:
Location before ICU admission in MOH hospitals 2004 - 2009
Location
2004
(%)
2005
(%)
2006
(%)
2007
(%)
2008
(%)
2009
(%)
Ward
33.4
32.5
32.8
37.2
34.5
37.5
Operation theatre
42.8
45.4
40.6
35.7
36.2
31.5
Emergency department
9.0
9.3
12.6
13.2
16.7
20.5
Other critical areas
11.8
9.6
9.0
7.3
6.5
4.4
Other locations
0.2
0.4
0.5
0.4
0.6
0.7
Other hospitals
2.8
2.8
4.5
6.1
5.6
5.5
The percentage of admissions from the emergency department had increased
significantly more than two-fold over the last 6 years.
Inter-hospital transfers had also increased over the years.
31
Table 15:
Indication for ICU admission 2009
Indication
Beds > 12
n (%)
Hospitals
Beds < 12
Private
n (%)
n (%)
Mechanical ventilation
5853 (53.5)
4323 (52.8)
11 (0.5)
10187 (48.0)
Post-operative
ventilation
Planned
2998 (27.4)
1932 (23.6)
5 (0.2)
4935 (23.3)
Unplanned
419 (3.8)
283 (3.5)
12 (0.6)
714 (3.4)
Post-operative
monitoring/
intervention
Planned
559 (5.1)
580 (7.1)
285 (13.7)
1424 (6.7)
Unplanned
164 (1.5)
127 (1.6)
83 (4.0)
374 (1.8)
Non-operative
monitoring/intervention
949 (8.7)
938 (11.5)
1686 (81.0)
3573 (16.8)
Total
10942
(100.0)
8183
(100.0)
2082
(100.0)
21207
(100.0)
Planned admission:
Unplanned admission:
Figure 9:
Total
The decision for admission was made before the induction of anaesthesia.
The decision for admission was made after induction of anaesthesia.
Indication for ICU admission 2009
In 2009, more than 82.6% of ICU admissions had mechanical ventilation (including
postoperative ventilation) as an indication for admission in MOH hospitals
compared to 1.3% in the private hospital. Non-operative intervention and
monitoring was the main indication for ICU admission in the private hospital.
32
Table 16:
Main organ failure on ICU admission 2009
Hospitals
Main organ failure
Beds > 12
n (%)
Beds < 12
n (%)
Private
n (%)
Total
n (%)
Without organ failure
3404 (33.7)
2457 (34.1)
1422 (78.5)
7283 (38.1)
Cardiovascular
2696 (26.7)
1761 (24.5)
18 (1.0)
4475 (23.4)
Respiratory
1547 (15.3)
1450 (20.1)
40 (2.2)
3037 (15.9)
Neurological
1419 (14.0)
862 (12.0)
41 (2.3)
2322 (12.2)
Renal
592 (5.9)
382 (5.3)
138 (7.6)
1112 (5.8)
Haematological
357 (3.5)
209 (2.9)
139 (7.7)
705 (3.7)
Hepatic
85 (0.8)
76 (1.1)
13 (0.7)
174 (0.9)
10100 (100)
7197 (100)
1811 (100)
19108 (100)
Total
The definition of organ failure is based on the Sequential Organ Failure Assessment (SOFA) [1]
Figure 10:
Main organ failure on ICU admission, by hospitals 2009
In 2009, about a third of admissions to MOH ICUs did not have any organ failure in
comparison to the private hospital where two-thirds of admissions were without any organ
failure. In MOH ICUs, cardiovascular failure (39%) was the most common organ failure
during the first 24 hours of ICU admission, followed by respiratory (26%) and neurological
(20%). This is in contrast to 2003, where respiratory failure (57%) was the most common
organ failure followed by cardiovascular failure (19%).
33
Table 17:
Number of organ failure(s) on ICU admission 2009
Number of organ failure
Beds ≥ 12
n(%)
Hospitals
Beds < 12
Private
n(%)
n(%)
Without
3404 (33.7)
2457 (34.1)
1422 (78.5)
7283 (38.1)
Single
3087 (30.6)
2119 (29.4)
320 (17.7)
5526 (28.9)
Two
2272 (22.5)
1523 (21.2)
43 (2.4)
3838 (20.1)
Three
1020 (10.1)
792 (11.0)
18 (1.0)
1830 (9.6)
Four
271 (2.7)
253 (3.5)
8 (0.4)
532 (2.8)
Five
40 (0.4)
51 (0.7)
-
91 (0.5)
Six
6 (0.1)
2 (0.0)
-
8 (0.0)
10100 (100)
7197 (100)
1811 (100)
19108 (100)
Total
Figure 11:
Total
n(%)
Number of organ failure(s) on ICU admission 2009
In 2009, 38% of patients admitted to ICUs were without any organ failure, while 29%
had single organ failure. Many of the ICUs function as combined ICU/HDW and
this could be one of the reasons for the high proportion of patients admitted without
any organ failure.
34
Table 18:
Ten most common diagnoses leading to ICU admission 2009
Diagnosis
n
%
Head Injury
1120
10.2
Sepsis
848
7.7
Community acquired pneumonia
739
6.7
Gastrointestinal perforation (including anastomotic leak)
393
3.6
Dengue
388
3.5
Bronchial asthma
379
3.5
Chronic lower respiratory disease
321
2.9
Intraabdominal injury
285
2.6
Non-cardiogenic pulmonary oedema
257
2.3
Infection / gangrene of limb (including osteomyelitis,
251
2.3
Sepsis
806
9.8
Head injury
617
7.5
Community acquired pneumonia
572
7.0
Bronchial asthma
307
3.7
Gastrointestinal perforation ( including anastomotic leak)
281
3.4
Dengue
253
3.1
Chronic lower respiratory disease
240
2.9
Other abdominal / pelvic conditions
216
2.6
Gastrointestinal bleeding
210
2.6
Intraabdominal injury
200
2.4
Cerebrovascular disease
167
8.0
Ischaemic heart disease/ acute coronary syndrome
153
7.3
Dengue
150
7.2
Epilepsy
105
5.0
Gastrointestinal bleeding
104
5.0
Other CNS condition
97
4.7
Other disorders of the musculoskeletal system
96
4.6
Other abdominal/ pelvic conditions
95
4.6
Other renal / genito-urinary conditions
78
3.7
Other respiratory conditions
64
3.1
Hospitals with ICU beds ≥ 12
necrotizing fascitis)
Hospitals with ICU beds < 12
Private Hospital
35
Figure 12:
Ten most common diagnoses leading to ICU admission in MOH
hospitals 2009
Head injury, sepsis and community-acquired pneumonia remained the three most common
diseases leading to ICU admission in MOH hospitals over the past 6 years.
36
Table 19:
Ten most common diagnoses leading to ICU