Athaliah Reynolds, Staff Reporter

A STUDY recently conducted on the operations of the High Dependency Unit (HDU) at the Victoria Jubilee Hospital (VJH) in Kingston has found that over the last five years, 15 per cent of critically ill women admitted to the ward have died.

The HDU at the VJH was opened in 2003 to cater to critically ill obstetric cases, especially post-surgical deliveries to take the weight off the Intensive Care Unit at the Kingston Public Hospital (KPH). However, patients also include those diagnosed with non-obstetric problems, such as sickle-cell disease, cancer and cardiac complications.

Over the last five years, a total of 158 patients were admitted to the facility with complications, averaging about 32 admissions each month. The women ranged in ages from 14 to 75 years old.

Alarming figures

Of that number, there were 23 deaths, 16 of which were caused by obstetric related conditions, including haemorrhage, hyper-tensive disorders, sepsis and anaemia, while seven were non-obstetric cases. Twenty-seven of the women were later transferred to the KPH's Intensive Care Unit.

Lead reviewer, Denese McFarlene, who is also a nurse educator in the Critical Care Unit at KPH, pointed out that although 15 per cent mortality might initially seem alarming, the HDU at the VJH was operating well within internationally accepted standards. The international range is 2.3 per cent to 22 per cent mortality.

She said the unit had a survival rate of 60-70 per cent, which was quite good. This, she noted, was achieved even with very minimal equipment and manpower.

The unit currently has only two beds; therefore only two patients can be admitted to the ward at any given time. Additionally, the KPH has only four trained critical care nurses. The study pointed out that this was way below accepted standards as just for the HDU alone the hospital would need about six to eight nurses, at least three to every patient.

Lack of antenatal care

She said at present, most nurses are required to work extremely long hours, some even working 24-hour shifts.

McFarlene further revealed that one of the main factors contributing to the death of some patients was a lack of antenatal care. She said of the 23 deaths, only six received previous care from any medical doctor.

She said the review showed that many of the mothers throughout their pregnancy only visited the hospital when it was time to give birth.

"The main causes of the deaths were pregnancy induced hypertension and pre-clamsia," she said. "These mothers, if we could catch them in the antenatal period, if they would come in for visits, then maybe we could catch them earlier and then they could be treated, but most of them come in when they are about to deliver, when they are very ill."

She said many of the women are not first-time mothers; however, they still show an indifference to coming in for antenatal care.

"Many of them live around the hospital, they know it's here. They know if they get ill, they can just run and they will have to be seen," she said.

McFarlene said perhaps an in-depth public education campaign was necessary to educate women on the importance of antenatal care - that it often could be a matter of life or death.

Recommendations

The review also recommended a further development of the unit to accommodate more patients and improve care. A critical part of this is the addition of more beds and trained ICU nurses to manage the area.

It was also suggested that the HDU have an assigned physician who would concentrate on that particular area.

It has also been proposed that other HDUs be developed at other hospitals across the island, as a large number of those admitted at the VJH were transfers coming mainly from the Spanish Town and St Ann's Bay hospitals.

McFarlene, however, noted that the shortage of trained ICU staff was one of the main factors hindering this proposal, as the units could not run without the necessary staff.

Hospital administration is hoping that corporate Jamaica will give a hand in helping to maintain the unit. It is hoped that an artiste or corporate entity may be willing to adopt the ward by making annual contributions in order to ensure that the work is sustained.

athaliah.Reynolds@gleanerjm.com