Intensive care unit occupancy and premature discharge rates: A cohort study assessing the reporting of quality indicators

TY - JOUR

T1 - Intensive care unit occupancy and premature discharge rates

T2 - A cohort study assessing the reporting of quality indicators

AU - Scottish Intensive Care Society Audit Group

AU - Blayney, M. C.

AU - Donaldson, L.

AU - Smith, P.

AU - Wallis, C.

AU - Cole, S.

AU - Lone, N. I.

N1 - This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

PY - 2020/2

Y1 - 2020/2

N2 - Purpose: ICU occupancy fluctuates. High levels may disadvantage patients. Currently, occupancy is benchmarked annually which may inaccurately reflect strained units. Outcomes potentially sensitive to occupancy include premature (early) ICU discharge and non-clinical transfer (NCT). This study assesses the association between daily occupancy and these outcomes, and evaluates benchmarking care across Scotland using daily occupancy.Materials and methods: Population: all Scottish ICU patients, 2006–2014. Exposure: bed occupancy per unit-day; Outcomes: proportion of early discharges and NCTs. Design: Retrospective cohort study. Outcome rates were calculated above various occupancy thresholds. Polynomial regression visualised associations, and inflection points between occupancy and outcomes. Spearman's rho correlations between occupancy measures and outcomes were reported. Results: 65,472 discharges occurred over 57,812 unit-days. 1954(3.0%) discharges were early; 429 (0.7%) were NCTs. Early discharge rates above 70%, 80% and 90% occupancy were 3.9%, 5.0% and 7.5% respectively. Occupancies at which outcome rates greatly increased were near 80% for early discharge, and 90% for NCT. Mean annual occupancy was not correlated with outcomes; annual proportion of days ≥90% occupancy correlated most strongly (early discharge rho = 0.46,p <.001; NCT rho = 0.31, p < .001).Conclusions: We demonstrate a clear association between daily ICU occupancy and early discharge/NCT. Daily occupancy may better benchmark care quality than mean annual occupancy.

AB - Purpose: ICU occupancy fluctuates. High levels may disadvantage patients. Currently, occupancy is benchmarked annually which may inaccurately reflect strained units. Outcomes potentially sensitive to occupancy include premature (early) ICU discharge and non-clinical transfer (NCT). This study assesses the association between daily occupancy and these outcomes, and evaluates benchmarking care across Scotland using daily occupancy.Materials and methods: Population: all Scottish ICU patients, 2006–2014. Exposure: bed occupancy per unit-day; Outcomes: proportion of early discharges and NCTs. Design: Retrospective cohort study. Outcome rates were calculated above various occupancy thresholds. Polynomial regression visualised associations, and inflection points between occupancy and outcomes. Spearman's rho correlations between occupancy measures and outcomes were reported. Results: 65,472 discharges occurred over 57,812 unit-days. 1954(3.0%) discharges were early; 429 (0.7%) were NCTs. Early discharge rates above 70%, 80% and 90% occupancy were 3.9%, 5.0% and 7.5% respectively. Occupancies at which outcome rates greatly increased were near 80% for early discharge, and 90% for NCT. Mean annual occupancy was not correlated with outcomes; annual proportion of days ≥90% occupancy correlated most strongly (early discharge rho = 0.46,p <.001; NCT rho = 0.31, p < .001).Conclusions: We demonstrate a clear association between daily ICU occupancy and early discharge/NCT. Daily occupancy may better benchmark care quality than mean annual occupancy.

KW - ICU

KW - Occupancy

KW - Premature discharges

KW - Quality measures: patient care

UR - https://www.scopus.com/pages/publications/85074648649

U2 - 10.1016/j.jcrc.2019.09.018

DO - 10.1016/j.jcrc.2019.09.018

M3 - Article

C2 - 31715526

AN - SCOPUS:85074648649

SN - 0883-9441

VL - 55

SP - 100

EP - 107

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -