Research Activities, March 2014
Strained intensive care units result in shorter stays in the units before discharge to floor
Patient Safety and Quality of Care
A projected shortage of intensivists coupled with an aging population may create a significant strain on U.S. intensive care units (ICUs), with providers having to care for a greater number of sicker patients with increases in patient turnover. Some are concerned that this strain on capacity may result in patients being discharged from the ICU sooner than desired to open an ICU bed or may influence the quality of provider communication at the time of patient handoffs.
In order to determine whether increased capacity strain influences the outcomes of patients discharged from ICUs, the researchers studied the associations between three metrics of ICU capacity strain measured on the day of ICU discharge and the risk-adjusted outcomes of 200,730 critically ill adults discharged from 155 U.S. ICUs to hospital floors from 2001 to 2008.
The three measures of ICU capacity strain included ICU census (the number of patients spending at least 2 hours in the ICU each day), ICU admissions (the proportion of the daily census comprised of new admissions), and ICU acuity (average predicted probability of death of other patients in the ICU at the time of a patient's ICU discharge). After adjusting for the severity-of-illness of the discharged patients, the authors found that all three capacity strain variables were inversely associated with ICU length of stay.
This suggests that increased strain results in providers discharging patients from the ICU more quickly. While this study found a very small increase in the risk of these patients being readmitted to the ICU, the good news is that no capacity strain variable was directly associated with post-ICU discharge mortality, hospital length of stay, or patients' ultimate hospital discharge disposition.
According to the researchers, bed pressures appear to influence physicians' bed allocation decisions without adversely impacting important patient outcomes such as death or the probability of being discharged home from the hospital. Rather than confirm fears of critical care rationing, increases in capacity strain may increase provider efficiency by limiting the extension of low-value critical care. The study was supported in part by AHRQ (HS18406).
See "Outcomes among patients discharged from busy intensive care units," by Jason Wagner, M.D., M.S.H.P., Nicole B. Gabler, Ph.D., Sarah J. Ratcliffe, Ph.D., and others in the October 1, 2013, Annals of Internal Medicine 159(7), pp. 447-455.