Ann Intern Med. 2013 Oct 1;159(7):447-55. doi: 10.7326/0003-4819-159-7-201310010-00004.
Strains on the capacities of intensive care units (ICUs) may influence the quality of ICU-to-floor transitions.
To determine how 3 metrics of ICU capacity strain (ICU census, new admissions, and average acuity) measured on days of patient discharges influence ICU length of stay (LOS) and post-ICU discharge outcomes.
Retrospective cohort study from 2001 to 2008.
155 ICUs in the United States.
200 730 adults discharged from ICUs to hospital floors.
Associations between ICU capacity strain metrics and discharged patient ICU LOS, 72-hour ICU readmissions, subsequent in-hospital death, post-ICU discharge LOS, and hospital discharge destination.
Increases in the 3 strain variables on the days of ICU discharge were associated with shorter preceding ICU LOS (all P < 0.001) and increased odds of ICU readmissions (all P < 0.050). Going from the 5th to 95th percentiles of strain was associated with a 6.3-hour reduction in ICU LOS (95% CI, 5.3 to 7.3 hours) and a 1.0% increase in the odds of ICU readmission (CI, 0.6% to 1.5%). No strain variable was associated with increased odds of subsequent death, reduced odds of being discharged home from the hospital, or longer total hospital LOS.
Long-term outcomes could not be measured.
When ICUs are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly and, perhaps consequentially, have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected. These results suggest that bed availability pressures may encourage physicians to discharge patients from the ICU more efficiently and that ICU readmissions are unlikely to be causally related to patient outcomes.
Agency for Healthcare Research and Quality; National Heart, Lung, and Blood Institute; and Society of Critical Care Medicine.
重症监护病房（ICU）的能力压力可能会影响 ICU 到病房的过渡质量。
确定 ICU 容量压力的 3 项指标（ICU 普查、新入院和平均严重程度）在患者出院日测量时如何影响 ICU 住院时间（LOS）和 ICU 出院后结局。
2001 年至 2008 年的回顾性队列研究。
美国 155 个 ICU。
200730 名从 ICU 转至医院病房的成年人。
ICU 容量压力指标与出院患者 ICU LOS、72 小时 ICU 再入院、随后院内死亡、ICU 出院后 LOS 和医院出院去向之间的关联。
在 ICU 出院日，3 种压力变量的增加与 ICU 住院时间的缩短相关（均 P < 0.001），ICU 再入院的可能性增加（均 P < 0.050）。从压力的第 5 百分位到第 95 百分位，ICU LOS 减少 6.3 小时（95%CI，5.3 至 7.3 小时），ICU 再入院的可能性增加 1.0%（CI，0.6%至 1.5%）。没有压力变量与随后死亡的可能性增加、出院回家的可能性降低或总住院时间延长相关。
无法测量长期结局。
当 ICU 紧张时，分诊决策似乎受到影响，导致患者更快地从 ICU 出院，并且可能因此 ICU 再入院的可能性略高。然而，短期患者结局不受影响。这些结果表明，床位可用性压力可能鼓励医生更有效地将患者从 ICU 出院，并且 ICU 再入院不太可能与患者结局有因果关系。
美国医疗保健研究与质量局；美国国家心肺血液研究所；和重症监护医学学会。
