Sean M Bagshaw1, Xioaming Wang2, David A Zygun3, Dan Zuege4, Peter Dodek5, Allan Garland6, Damon C Scales7, Luc Berthiaume8, Peter Faris9, Guanmin Chen10, Dawn Opgenorth11, Henry T Stelfox12. 1. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 ST NW, Edmonton, Alberta, Canada; Alberta Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: bagshaw@ualberta.ca. 2. Research Facilitation, Research Priorities & Implementation, Research Innovation and Analytics, Alberta Health Services, Alberta, Canada. Electronic address: xiaoming.wang@albertahealthservices.ca. 3. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 ST NW, Edmonton, Alberta, Canada; Alberta Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: zygun@ualberta.ca. 4. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: dan.zuege@albertahealthservices.ca. 5. Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, B.C., Canada. Electronic address: peter.dodek@ubc.ca. 6. Division of Critical Care Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: agarland@exchange.hsc.mb.ca. 7. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada. Electronic address: damon.scales@sunnybrook.ca. 8. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: luc.berthiaume@albertahealthservices.ca. 9. Research Facilitation, Research Priorities & Implementation, Research Innovation and Analytics, Alberta Health Services, Alberta, Canada. Electronic address: peter.faris@albertahealthservices.ca. 10. Alberta Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada; Research Facilitation, Research Priorities & Implementation, Research Innovation and Analytics, Alberta Health Services, Alberta, Canada. Electronic address: guanmin.chen@albertahealthservices.ca. 11. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 ST NW, Edmonton, Alberta, Canada. Electronic address: dawno@ualberta.ca. 12. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: tstelfox@ucalgary.ca.
Abstract
PURPOSE: To evaluate the associations between strained ICU capacity and patient outcomes. METHODS: Multi-center population-based cohort study of nine integrated ICUs in Alberta, Canada. Path-analysis modeling was adopted to investigate direct and indirect associations between strain (available beds ≤1; occupancy ≥95%) and outcomes. Mixed-effects multivariate regression was used to measure the association between strain and acuity (APACHE II score), and both acuity and strain measures on ICU mortality and length of stay. RESULTS: 12,265 admissions comprise the study cohort. Available beds ≤1 and occupancy ≥95% occurred for 22.3% and 17.0% of admissions. Lower bed availability was associated with higher APACHE II score (p<0.0001). The direct effect of ≤1 available beds at ICU admission on ICU mortality was 11.6% (OR 1.116; 95% CI, 0.995-1.252). Integrating direct and indirect effects resulted in a 16.5% increased risk of ICU mortality (OR 1.165; 95% CI, 1.036-1.310), which exceeded the direct effect by 4.9%. Findings were similar with strain defined as occupancy ≥95%. Strain was associated with shorter ICU stay, primarily mediated by greater acuity. CONCLUSIONS: Strained capacity was associated with increased ICU mortality, partly mediated through greater illness acuity. Future work should consider both the direct and indirect relationships of strain on outcomes.
PURPOSE: To evaluate the associations between strained ICU capacity and patient outcomes. METHODS: Multi-center population-based cohort study of nine integrated ICUs in Alberta, Canada. Path-analysis modeling was adopted to investigate direct and indirect associations between strain (available beds ≤1; occupancy ≥95%) and outcomes. Mixed-effects multivariate regression was used to measure the association between strain and acuity (APACHE II score), and both acuity and strain measures on ICU mortality and length of stay. RESULTS: 12,265 admissions comprise the study cohort. Available beds ≤1 and occupancy ≥95% occurred for 22.3% and 17.0% of admissions. Lower bed availability was associated with higher APACHE II score (p<0.0001). The direct effect of ≤1 available beds at ICU admission on ICU mortality was 11.6% (OR 1.116; 95% CI, 0.995-1.252). Integrating direct and indirect effects resulted in a 16.5% increased risk of ICU mortality (OR 1.165; 95% CI, 1.036-1.310), which exceeded the direct effect by 4.9%. Findings were similar with strain defined as occupancy ≥95%. Strain was associated with shorter ICU stay, primarily mediated by greater acuity. CONCLUSIONS: Strained capacity was associated with increased ICU mortality, partly mediated through greater illness acuity. Future work should consider both the direct and indirect relationships of strain on outcomes.
Authors: Sean M Bagshaw; Henry T Stelfox; Theodore J Iwashyna; Rinaldo Bellomo; Dan Zuege; Xioaming Wang Journal: Intensive Care Med Date: 2018-11-12 Impact factor: 17.440
Authors: Adam M Hall; Henry T Stelfox; Xioaming Wang; Guanmin Chen; Danny J Zuege; Peter Dodek; Allan Garland; Damon C Scales; Luc Berthiaume; David A Zygun; Sean M Bagshaw Journal: Crit Care Date: 2018-04-17 Impact factor: 9.097
Authors: Bernard Lambermont; Anne-Françoise Rousseau; Laurence Seidel; Marie Thys; Jonathan Cavalleri; Pierre Delanaye; J Geoffrey Chase; Pierre Gillet; Benoit Misset Journal: Crit Care Explor Date: 2021-05-19
Authors: Oleksa G Rewa; Henry T Stelfox; Armann Ingolfsson; David A Zygun; Robin Featherstone; Dawn Opgenorth; Sean M Bagshaw Journal: Crit Care Date: 2018-03-27 Impact factor: 9.097