Factors influencing length of stay in the intensive care unit.

BACKGROUND: Long stays in the intensive care unit are associated with high costs and burdens on patients and patients' families and in turn affect society at large. Although factors that affect length of stay and outcomes of care in the intensive care unit have been studied extensively, the conclusions reached have not been reviewed to determine whether they reveal an organizational pattern that might be of practical use in reducing length of stay in the unit. OBJECTIVE: To identify and categorize the factors associated with prolonged stays in the intensive care unit and to describe briefly the nonmedical interventions to date designed to reduce length of stay. METHODS: Articles published between January 1990 and March 2005 in English-language journals indexed by MEDLINE were searched for studies on outcomes and costs of care in the intensive care unit and on care at the end of life. RESULTS: The emerging consensus is that length of stay in the intensive care unit is exacerbated by several increasingly discernible medical, social, psychological, and institutional factors. At the same time, several nonmedical, experimental interventions have been designed to reduce length of stay. CONCLUSIONS: Interventions involving palliative care, ethics consultations, and other methods to increase communication between healthcare personnel, patients, and patients' families may be helpful in decreasing length of stay in the intensive care unit. Further studies are needed to provide a strategy for targeting specific risk factors indicated by the literature review.