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High occupancy increases the risk of early death or readmission after transfer from intensive care.
Crit Care Med. 2009 Oct; 37(10):2753-8.CC

Abstract

OBJECTIVE

To determine whether a lack of intensive care unit beds was leading to premature patient discharge from the intensive care unit and subsequent early readmission or death.

DESIGN

Prospective cohort study.

SETTING

A single Canadian tertiary care teaching hospital.

PATIENTS

All intensive care unit admissions between January 1, 1989 and December 31, 1996 were collected prospectively for inclusion in a registry database.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

There was a positive correlation between early readmission or death and average quarterly intensive care unit percent occupancy (p = .001). During the study period, 8693 patients experienced 10,185 admissions to intensive care. Of the 8222 patients remaining under active treatment (patients under palliative care were excluded), there were 455 (5.5%) adverse events (431 intensive care unit readmissions and 24 deaths) in the first 7 days post intensive care unit discharge. Patients requiring a new surgical intervention with postoperative intensive care unit admission were not considered readmissions. In a multivariate analysis, significant risk factors for an adverse event included age >35 yrs, particular diagnoses (respiratory diagnoses, sepsis, neurosurgery, thoracic surgery, and gastrointestinal diagnoses), Acute Physiology and Chronic Health Evaluation II score, and intensive care unit length of stay. Discharge from the intensive care unit at a time of no vacancy was also a significant risk factor for intensive care unit readmission or unexpected death with an adjusted relative risk of 1.56 (95% confidence interval 1.05, 2.31).

CONCLUSIONS

Increased patient occupancy within an intensive care unit is associated with an increased risk of early death or intensive care unit readmission post intensive care unit discharge. Overloading the capacity of an intensive care unit to care for critically ill patients may affect physician decision-making, resulting in premature discharge from the intensive care unit.

Authors+Show Affiliations

Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada. carla.chrusch@albertahealthservices.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19707139

Citation

Chrusch, Carla A., et al. "High Occupancy Increases the Risk of Early Death or Readmission After Transfer From Intensive Care." Critical Care Medicine, vol. 37, no. 10, 2009, pp. 2753-8.
Chrusch CA, Olafson KP, McMillan PM, et al. High occupancy increases the risk of early death or readmission after transfer from intensive care. Crit Care Med. 2009;37(10):2753-8.
Chrusch, C. A., Olafson, K. P., McMillan, P. M., Roberts, D. E., & Gray, P. R. (2009). High occupancy increases the risk of early death or readmission after transfer from intensive care. Critical Care Medicine, 37(10), 2753-8. https://doi.org/10.1097/CCM.0b013e3181a57b0c
Chrusch CA, et al. High Occupancy Increases the Risk of Early Death or Readmission After Transfer From Intensive Care. Crit Care Med. 2009;37(10):2753-8. PubMed PMID: 19707139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High occupancy increases the risk of early death or readmission after transfer from intensive care. AU - Chrusch,Carla A, AU - Olafson,Kendiss P, AU - McMillan,Patricia M, AU - Roberts,Daniel E, AU - Gray,Perry R, PY - 2009/8/27/entrez PY - 2009/8/27/pubmed PY - 2009/11/17/medline SP - 2753 EP - 8 JF - Critical care medicine JO - Crit Care Med VL - 37 IS - 10 N2 - OBJECTIVE: To determine whether a lack of intensive care unit beds was leading to premature patient discharge from the intensive care unit and subsequent early readmission or death. DESIGN: Prospective cohort study. SETTING: A single Canadian tertiary care teaching hospital. PATIENTS: All intensive care unit admissions between January 1, 1989 and December 31, 1996 were collected prospectively for inclusion in a registry database. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There was a positive correlation between early readmission or death and average quarterly intensive care unit percent occupancy (p = .001). During the study period, 8693 patients experienced 10,185 admissions to intensive care. Of the 8222 patients remaining under active treatment (patients under palliative care were excluded), there were 455 (5.5%) adverse events (431 intensive care unit readmissions and 24 deaths) in the first 7 days post intensive care unit discharge. Patients requiring a new surgical intervention with postoperative intensive care unit admission were not considered readmissions. In a multivariate analysis, significant risk factors for an adverse event included age >35 yrs, particular diagnoses (respiratory diagnoses, sepsis, neurosurgery, thoracic surgery, and gastrointestinal diagnoses), Acute Physiology and Chronic Health Evaluation II score, and intensive care unit length of stay. Discharge from the intensive care unit at a time of no vacancy was also a significant risk factor for intensive care unit readmission or unexpected death with an adjusted relative risk of 1.56 (95% confidence interval 1.05, 2.31). CONCLUSIONS: Increased patient occupancy within an intensive care unit is associated with an increased risk of early death or intensive care unit readmission post intensive care unit discharge. Overloading the capacity of an intensive care unit to care for critically ill patients may affect physician decision-making, resulting in premature discharge from the intensive care unit. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/19707139/High_occupancy_increases_the_risk_of_early_death_or_readmission_after_transfer_from_intensive_care_ L2 - https://dx.doi.org/10.1097/CCM.0b013e3181a57b0c DB - PRIME DP - Unbound Medicine ER -