TY - JOUR
T1 - Associations between hospital occupancy, intensive care unit transfer delay and hospital mortality
AU - Ofoma, Uchenna R.
AU - Montoya, Juan
AU - Saha, Debdoot
AU - Berger, Andrea
AU - Kirchner, H. Lester
AU - McIlwaine, John K.
AU - Kethireddy, Shravan
N1 - Funding Information:
This work was supported by funding from the Geisinger Health System Foundation .
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Purpose: Hospital occupancy (HospOcc) pressures often lead to longer intensive care unit (ICU) stay after physician recognition of discharge readiness. We evaluated the relationships between HospOcc, extended ICU stay, and patient outcomes. Materials and methods: 7-year retrospective cohort study of 8500 alive discharge encounters from 4 adult ICUs of a tertiary hospital. We estimated associations between i) HospOcc and ICU transfer delay; and ii) ICU transfer delay and hospital mortality. Results: Median (IQR) ICU transfer delay was 4.8 h (1.6–11.7), 1.4% (119) suffered in-hospital death, and 4% (341) were readmitted. HospOcc was non-linearly related with ICU transfer delay, with a spline knot at 80% (mean transfer delay 8.8 h [95% CI: 8.24, 9.38]). Higher HospOcc level above 80% was associated with longer transfer delays, (mean increase 5.4% per % HospOcc increase; 95% CI, 4.7 to 6.1; P < .001). Longer ICU transfer delay was associated with increasing odds of in-hospital death or ICU readmission (odds ratio 1.01 per hour; 95% CI 1.00 to 1.01; P = .04) but not with ICU readmission alone (OR 1.01 per hour; 95% CI 1.00 to 1.01, P = .14). Conclusions: ICU transfer delay exponentially increased above a threshold hospital occupancy and may be associated with increased hospital mortality.
AB - Purpose: Hospital occupancy (HospOcc) pressures often lead to longer intensive care unit (ICU) stay after physician recognition of discharge readiness. We evaluated the relationships between HospOcc, extended ICU stay, and patient outcomes. Materials and methods: 7-year retrospective cohort study of 8500 alive discharge encounters from 4 adult ICUs of a tertiary hospital. We estimated associations between i) HospOcc and ICU transfer delay; and ii) ICU transfer delay and hospital mortality. Results: Median (IQR) ICU transfer delay was 4.8 h (1.6–11.7), 1.4% (119) suffered in-hospital death, and 4% (341) were readmitted. HospOcc was non-linearly related with ICU transfer delay, with a spline knot at 80% (mean transfer delay 8.8 h [95% CI: 8.24, 9.38]). Higher HospOcc level above 80% was associated with longer transfer delays, (mean increase 5.4% per % HospOcc increase; 95% CI, 4.7 to 6.1; P < .001). Longer ICU transfer delay was associated with increasing odds of in-hospital death or ICU readmission (odds ratio 1.01 per hour; 95% CI 1.00 to 1.01; P = .04) but not with ICU readmission alone (OR 1.01 per hour; 95% CI 1.00 to 1.01, P = .14). Conclusions: ICU transfer delay exponentially increased above a threshold hospital occupancy and may be associated with increased hospital mortality.
KW - Critical care utilization
KW - ICU discharge delay
KW - ICU strain
KW - ICU transfer delay
KW - Organizational efficiency
KW - Work flow
UR - http://www.scopus.com/inward/record.url?scp=85083557740&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2020.04.009
DO - 10.1016/j.jcrc.2020.04.009
M3 - Article
C2 - 32339974
AN - SCOPUS:85083557740
SN - 0883-9441
VL - 58
SP - 48
EP - 55
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -