Use of Clinical Triage Criteria Decreases Monitored Care Bed Utilization in Gallstone Pancreatitis

摘要

Admission indicators for monitored care in gallstone pancreatitis have been lacking. Recently, we established three criteria for admission to intensive care unit or step down versus ward beds: 1) concomitant cholangitis, 2) heart rate > 110 beats/min, and 3) blood urea nitrogen > 15 mg/dL. The purpose of this study was to determine whether these criteria would be effective in decreasing monitored care bed utilization without adversely affecting outcomes. A retrospective review of all patients with gallstone pancreatitis at a public teaching hospital was performed (2003-2009). A comparison was made of patients before (2003-2005, Period 1) and after (2006-2009, Period 2) establishment of monitored care triage criteria. Over the study period, there were 379 patients. The median Ranson score for both periods was 1. The median ages were 41 and 39, (P = 0.7). In Period 1,28 per cent of patients were admitted to the intensive care unit/step down unit versus 12 per cent in Period 2. None of the patients required transfer from the ward to a monitored care setting in Period 2. There were no mortalities in either period. In conclusion, the presence of concomitant cholangitis, heart rate >110, and blood urea nitrogen > 15 are useful and safe triage criteria for admission to a monitored care setting. Use of these criteria significantly decreased monitored care bed utilization and resulted in fewer mis-triages without adversely affecting patient outcomes.