Associations between hospital occupancy,intensive care unit transfer delay and hospital mortality |
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| Affiliation: | 1. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;2. Department of Pathophysiology and Transplantation, University of Milan, Italy;1. Intensive Care Unit, Hospital Punta de Europa, Ctra. Getares, s/n, 11207 Algeciras, Cádiz, Spain;2. Hospital Punta de Europa, Algeciras, Cádiz, Spain;3. Centro de Salud La Lobilla, Estepona, Málaga, Spain;1. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;2. Critical Care Department, Vall d''Hebron University Hospital, Vall d''Hebron Research Institute, Barcelona, Spain;3. Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain;4. Department of Pathophysiology and Transplantation, University of Milan, Italy;1. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy;2. Vita-Salute San Raffaele University, Milan, Italy;3. Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia;4. Novosibirsk State University, Novosibirsk, Russia;5. Division of Cardiac Anesthesia and Intensive Care Unit, AORN dei Colli – Monaldi Hospital, Naples, Italy;6. Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy;7. Department of Surgical Sciences, University of Turin, Turin, Italy;8. Intensive Care Unit, Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia;9. Division of Cardiothoracic Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, AOU Pisana, Pisa, Italy;10. Department of Anesthesia and Intensive Care, AOU Mater Domini Germaneto, Catanzaro, Italy;11. Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia;12. V. Negovsky Reanimatology Research Institute, Moscow, Russia;13. Department of Anesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy;14. Department of Anesthesiology and Intensive Care, Federal Center for Cardiovascular Surgery Astrakhan, Astrakhan, Russia;15. Department of Cardiovascular Anesthesia and Intensive Care, AO Ordine Mauriziano, Turin, Italy |
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| Abstract: | PurposeHospital 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 methods7-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.ResultsMedian (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).ConclusionsICU transfer delay exponentially increased above a threshold hospital occupancy and may be associated with increased hospital mortality. |
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