Pattern and outcomes of admissions to the Medical Acute Care Unit of a tertiary teaching hospital in South Africa

Abstract

Background A Medical Acute Care Unit (MACU) was established at Chris Hani Baragwanath Academic Hospital (CHBAH) to provide comprehensive medical specialist care to the patients presenting with acute medical emergencies. Improved standards of health care delivery systems at the MACU may result in shorter hospital stay, better outcomes and less mortality. Objectives The objective of the study was to describe the demographics, diagnoses, pattern of diseases and the outcomes, including mortality of patients admitted to the MACU at the Chris Hani Baragwanath Academic Hospital (CHBAH). Methods A record review of 200 patients admitted to the MACU at CHBAH was performed from March 2015 to August 2015. The records were analysed for patient demographics, diagnosis at admission and duration of stay in MACU. The outcome was defined as transfer to the medical ward, Intensive Care Unit (ICU) or discharged home. The main causes of mortality were also recorded. Results Of the 200 patients, 59% were females. The mean age of the patients was 46 ± 17.2 years and the mean duration of stay at the MACU was 1.45 ± 1.25 days. Noncommunicable diseases accounted for 76% of admissions. The most frequently diagnosed conditions included: diabetic ketoacidosis acidosis (DKA) and hyperosmolar non-ketotic (HONK) (17.5%), non-accidental self-poisoning (16%), hypertensive emergencies (9.5%), decompensated cardiac failure (8%) and ischemic v heart disease (7%). Infectious diseases comprised 14% of the diagnoses of which pneumonias were the most common (5%). Most patients (77.5%) were transferred to medical wards, 12% to ICU, while 10% demised at the MACU. The main causes of death included sepsis (25%), DKA/HONK (20%), non-accidental self-poisoning (10%) and cardiac failure (10%). Conclusion Non-communicable diseases particularly diabetic emergencies were the main causes of admission to the MACU at CHBAH. During the study period, high rates of case improvement, patient discharge, shorter hospital stay, and less mortality were observed. The main cause of mortality was sepsis related.