Intensive care unit bed shortage leading to a delay in patient admission to public intensive care units
© BioMed Central Ltd 2007
Published: 19 June 2007
ICU bed shortage is a daily problem that leads to delayed ICU treatment for those with an extended waiting time. This population is thought to have a bad prognosis, mainly those from wards. The objective of this study is to identify whether the delay between reference and ICU admissions caused by an ICU bed shortage could lead to a higher mortality rate in ER patients.
Materials and methods
All referrals consecutively made to the ICU of a public university hospital and not immediately admitted in the period June–December 2005 were included. Patients were evaluated prospectively to the final outcome regarded as admittance/nonadmittance. Each patient was described by demographic data, origin sector and waiting time. The vacancy reservation criterion adopted was hierarchy through a request order. Data from external requests to the hospital were not collected. For statistical analysis the Epi Info version 3.3.2 program was used.
Throughout the observation period, 629 referrals to the ICU were made, 42.4% of patients being immediately admitted. Out of 362 clinical referrals initially refused because of bed shortage, the male sex was more frequent (58.6%), and the mean age was 57.9 ± 19.0 years. Of all patients initially refused, 20.2% were cancelled due to patients' clinical recovery within 36 hours and 15.2% died before an available bed in a mean waiting time of 23.4 hours. Only 21 patients (5.8%) were transferred to another hospital, in a mean time of 17.9 hours. Of clinical patients later admitted to the ICU, the median waiting time was 24 hours (9–26.5 hours). Their mean age was no different from those who died before admission (57.8 ± 18.33 years). The origin sector was the ER in 62.5% of the requests. There was no difference between mortality of requests from the ER and from the ward (P = 0.17).
In this population, 57.6% of the demand for ICU beds was not admitted immediately. The waiting time for clinical admissions was very high, suggesting that time-sensitive diseases like sepsis had a worst prognosis. The mortality among ER patients waiting for ICU beds was no higher then ward patients. We suggest a study to evaluate the impact of delay on the prognosis of admitted patients.