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Patient outcome after reorganization of a medical intensive care unit
Critical Care volume 8, Article number: P326 (2004)
The outcome of patients admitted to the intensive care unit (ICU) may be related to ICU structure and care processes. This retrospective study aims to assess the impact of an increase in ICU bed capacity on patient outcome.
We identified 2524 patients admitted to a medical ICU between 8 December 2001 and 14 July 2003. The ICU initially had 15 beds (Period 1) and was staffed by a consultant, three fellows and eight residents. On 7 August 2002, the bed capacity expanded to 18 beds (Period 2) and on 18 December 2002 to 24 beds (Period 3). Starting 1 April 2002, a consultant and a fellow joined the staff. We collected demographics, admission source and diagnosis, observed ICU mortality and length of stay (LOS), observed hospital mortality and LOS, ICU readmission, first ICU day APACHE III score and predicted mortality rates. We calculated the predicted ICU LOS of each patient using a linear regression model customized for our patient population. Excess ICU LOS was defined as the difference between the observed and predicted ICU LOS. The hospital mortality rate was adjusted for severity of illness. P < 0.05 was considered significant.
The observed ICU LOS was shorter (Table 1) in Period 3 compared with Period 2 (P = 0.017). The excess ICU LOS was different between Periods 1 and 2 (P = 0.019), and Periods 2 and 3 (P = 0.028).
Provided adequate physician staffing levels are maintained, an increase in ICU bed capacity is not associated with worse clinical outcomes in critically ill patients. This may have implications for intensivists and policy-makers.
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Dara, S., Afessa, B. Patient outcome after reorganization of a medical intensive care unit. Crit Care 8 (Suppl 1), P326 (2004). https://doi.org/10.1186/cc2793