Nicholas A Fergusson1, Steve Ahkioon2, Mahesh Nagarajan3, Eric Park4, Yichuan Ding3, Najib Ayas5, Vinay K Dhingra5, Dean R Chittock5, Donald E G Griesdale6,7,8. 1. University of British Columbia, Vancouver, BC, Canada. 2. Vancouver Coastal Health, Vancouver, BC, Canada. 3. Sauder School of Business, University of British Columbia, Vancouver, BC, Canada. 4. Faculty of Business and Economics, University of Hong Kong, Pokfulam, Hong Kong. 5. Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 6. Department of Anesthesiology, Pharmacology, Therapeutics, University of British Columbia, Vancouver, BC, Canada. donald.griesdale@vch.ca. 7. Department of Medicine, Divisions of Critical Care Medicine and Neurology, University of British Columbia, Vancouver, BC, Canada. donald.griesdale@vch.ca. 8. Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada. donald.griesdale@vch.ca.
Abstract
PURPOSE: There is conflicting evidence regarding the influence of intensive care unit (ICU) occupancy at the time of admission on important patient outcomes such as mortality. The objective of this analysis was to characterize the association between ICU occupancy at the time of ICU admission and subsequent mortality. METHODS: This single-centre, retrospective cohort study included all patients admitted to the ICU at the Vancouver General Hospital between 4 January 2010 and 8 October 2017. Intensive care unit occupancy was defined as the number of ICU bed hours utilized in a day divided by the total amount of ICU bed hours available for that day. We constructed mixed-effects logistic regression models controlling for relevant covariates to assess the impact of admission occupancy quintiles on total inpatient (ICU and ward) and early (72-hr) ICU mortality. RESULTS: This analysis included 10,365 ICU admissions by 8,562 unique patients. Compared with ICU admissions in the median occupancy quintile, admissions in the highest and second highest occupancy quintile were associated with a significant increase in the odds of inpatient mortality (highest: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.12 to 1.59; P value < 0.001; second highest: OR, 1.21; 95% CI, 1.02 to 1.44; P value < 0.03). No association between admission occupancy and 72-hr ICU mortality was observed. CONCLUSIONS: Admission to the ICU on days of high occupancy was associated with increased inpatient mortality, but not with increased 72-hr ICU mortality. Capacity strain on the ICU may result in significant negative consequences for patients, but further research is needed to fully characterize the complex effects of capacity strain.
PURPOSE: There is conflicting evidence regarding the influence of intensive care unit (ICU) occupancy at the time of admission on important patient outcomes such as mortality. The objective of this analysis was to characterize the association between ICU occupancy at the time of ICU admission and subsequent mortality. METHODS: This single-centre, retrospective cohort study included all patients admitted to the ICU at the Vancouver General Hospital between 4 January 2010 and 8 October 2017. Intensive care unit occupancy was defined as the number of ICU bed hours utilized in a day divided by the total amount of ICU bed hours available for that day. We constructed mixed-effects logistic regression models controlling for relevant covariates to assess the impact of admission occupancy quintiles on total inpatient (ICU and ward) and early (72-hr) ICU mortality. RESULTS: This analysis included 10,365 ICU admissions by 8,562 unique patients. Compared with ICU admissions in the median occupancy quintile, admissions in the highest and second highest occupancy quintile were associated with a significant increase in the odds of inpatient mortality (highest: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.12 to 1.59; P value < 0.001; second highest: OR, 1.21; 95% CI, 1.02 to 1.44; P value < 0.03). No association between admission occupancy and 72-hr ICU mortality was observed. CONCLUSIONS: Admission to the ICU on days of high occupancy was associated with increased inpatient mortality, but not with increased 72-hr ICU mortality. Capacity strain on the ICU may result in significant negative consequences for patients, but further research is needed to fully characterize the complex effects of capacity strain.
Authors: Anish R Mitra; Nicholas A Fergusson; Elisa Lloyd-Smith; Andrew Wormsbecker; Denise Foster; Andrei Karpov; Sarah Crowe; Greg Haljan; Dean R Chittock; Hussein D Kanji; Mypinder S Sekhon; Donald E G Griesdale Journal: CMAJ Date: 2020-05-27 Impact factor: 8.262
Authors: Anish R Mitra; Nicholas A Fergusson; Elisa Lloyd-Smith; Andrew Wormsbecker; Denise Foster; Andrei Karpov; Sarah Crowe; Greg Haljan; Dean R Chittock; Hussein D Kanji; Mypinder S Sekhon; Donald E G Griesdale Journal: CMAJ Date: 2020-11-23 Impact factor: 8.262
Authors: Maxime Volff; David Tonon; Youri Bommel; Noémie Peres; David Lagier; Geoffray Agard; Alexis Jacquier; Axel Bartoli; Julien Carvelli; Howard Max; Pierre Simeone; Valery Blasco; Bruno Pastene; Anderson Loundou; Laurent Boyer; Marc Leone; Lionel Velly; Jeremy Bourenne; Salah Boussen; Mickaël Bobot; Nicolas Bruder Journal: J Clin Med Date: 2021-11-30 Impact factor: 4.241