Consumption of ICU resources by long-stay patients does not change over time: 10-year observation in a teaching hospital in The Netherlands

Introduction

The steady increase of expected lifetime and mean age of man in the western world can only be accompanied by an increase in medical care and inherent use of ICU resources. Nowadays, one in five Americans dies using ICU care. We explored whether the use of ICU resources by long-stay patients has increased over time.

Methods

Data from all patients admitted to a 10-bed medical–surgical ICU in a university-affiliated teaching hospital in a 10-year period were analyzed. In the study period, organizational aspects such as the nurse-per-patient ratio and the number of intensivists remained stable. In the first 24 hours, the type of admission and medical history was recorded and APACHE II scores were calculated. After discharge, patients were divided into four groups with ICU length of stay (LOS) <3 days, 3–6 days, 7–13 days and ≥ 14 days. Data are shown as the median (interquartile range (IQR)).

Results

Over the years, the number of patients admitted per year was stable at a median 578 (IQR 535–588). Age (69 (65–76) years) was stable over the years and did not differ between LOS groups. APACHE II scores (12 (8–17)) were stable as well, while a longer ICU LOS was associated with higher scores. Hospital mortality was 18.5% (range 16.6–19.1%). The proportion of patients per year in the different LOS groups did not change over the years; that is, LOS <3 days: 62.5% (range 61.4–64.1%), LOS 3–6 days: 19.1% (range 18.9–20.1%), LOS 7–13 days: 9.8% (range 9.2–10.9%), and LOS ≥ 14 days: 8.6% (range 7.5–9.6%). The relatively small group of long-stay patients (≥ 14 days; n = 44 (39–51) per year) comprised predominantly medical admissions (65.5%) and consumed 54.6% of the yearly ICU treatment days. Mortality in this group (35.1%) was higher than in the groups with shorter length of ICU stay (14.2% in LOS <3 days, 17.1% in LOS 3–6 days and 27.0% in LOS 7–13 days; P < 0.001).

Conclusion

Consumption of ICU resources by long-stay patients was considerable, but did not change over time in our setting. Long-stay patients were predominantly medical admissions and showed the highest mortality. These findings are important in view of futility and costs.