Does Strain on ICU Capacity Take a Toll on Patients?

Patricia Anne Kritek, MD, EdM

Intensive care unit readmissions rose during stressful times, but mortality and length of stay were not affected.

As the U.S. population ages, demand for intensive care services is growing. At the same time, providers who care for critically ill patients are in short supply. Concern has been raised that, as intensive care unit (ICU) staff and providers are strained, patient outcomes will suffer. Investigators examined >200,000 patients admitted to 107 U.S. hospitals (155 ICUs) to assess the effects of three types of capacity strain: acuity, census, and admissions. Most hospitals were urban (59%) and community-based (72%), and most employed an open-ICU model without mandatory critical care (70%).

Three percent of patients were readmitted to ICUs within 72 hours of discharge to the floor. An increase of one patient in census was associated with a 3% increase in the odds of readmission. Similar small but significant increases in readmissions were associated with increases in acuity and admissions. The rate of readmission was not associated with mortality (in-hospital deaths after ICU stays, 4%). More importantly, whereas increases in all three strain variables were associated with shorter ICU lengths of stay, researchers noted no effect of strain on in-hospital mortality or length of stay.

Citation(s):

Wagner J et al. Outcomes among patients discharged from busy intensive care units. Ann Intern Med 2013 Oct 1; 159:447.