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Busy ICUs discharge patients more quickly, study finds

Wednesday November 27, 2013
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Busy ICUs discharge patients more quickly than they would with a normal patient volume and do so without adversely affecting short-term patient outcomes, according to a recent study.

The findings suggest low-value extensions of ICU stays are minimized when ICU capacity is under increased strain. The study, conducted by researchers with the University of Pennsylvania in Philadelphia, was published Oct. 1 in the Annals of Internal Medicine.

An expected increase in patients requiring critical care resources combined with a projected shortage in critical care providers likely will result in increasing strain on ICUs, leading to more competition for ICU beds among greater numbers of more seriously ill patients. Many fear this could lead to patients spending shorter periods of time in the ICU and experiencing worse health outcomes because of “rationing” of necessary critical care, according to a university news release.

However, the study, led by Jason Wagner, MD, MSHP, senior fellow, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania’s Perelman School of Medicine, found the bed crunch led to a reduction in low-value ICU care for patients who were nearing ICU discharge without adversely affecting patient outcomes.

The retrospective analysis included 200,730 adult patients discharged from 155 ICUs to other units in the U.S. from 2001-08. Researchers measured ICU capacity strain using ICU census, number of new admissions and the average acuity of the other ICU patients at the time of a patient’s discharge.

When ICUs were busiest — going from 5th to the 95th percentile of strain — patients were discharged an estimated 6.3 hours sooner, the authors found. Patients discharged from the busy ICUs did have a 1% greater chance of ICU readmission. However, such patients experienced no increase in their odds of dying in the hospital, no greater overall length of hospital stay, and no decrease in the odds of ultimately going home, researchers found.

They wrote that instead of causing rationing of beneficial care, strain spurs providers to reduce their provision of what seems to be low-value care by critically re-examining a patient’s need for ICU-level care and transferring patients who could be equally well-managed outside the ICU.

“Although the reductions in ICU length of stay during times of strain were modest, focusing efforts on achieving similar reductions in ICU length of stay for majority of patients admitted to the nearly 100,000 ICU beds in the United States could reduce the overall use of critical care in the country,” Wagner said in the news release. “Rather than reflexively moving towards the higher-cost approach of adding more ICU beds, perhaps more effort should be focused on increasing the efficiency with which we provide critical care services with our existing resources.”

Abstract: http://annals.org/article.aspx?articleid=1742592


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