从重症监护病房转出延迟：延迟院内转科的经济影响的前瞻性观察分析。
Delay of transfer from the intensive care unit: a prospective observational analysis on economic effects of delayed in-house transfer.
机构信息
Klinikum rechts der Isar, Technische Universität München, Klinik für Anästhesiologie, Munich, Germany.
School of Mathematics, Cardiff University, Cardiff, UK.
出版信息
Eur J Med Res. 2019 Sep 3;24(1):30. doi: 10.1186/s40001-019-0388-3.
BACKGROUND
Intensive care unit (ICU) capacity is a scant and precious resource in hospitals. Therefore, an optimal occupancy rate as well as detailed occupation planning is of great importance. Most literature deals with admission to the ICU, while only few discuss discharge from the ICU. Specifically, a delay of transfer from the ICU can cause a shortness of beds, jeopardize urgent patient treatment and lead to a decrease in treatment quality as well as economic downsides. This study examined the incidence, costs and reasons for delayed discharge from the ICU and analyzed the influence of the department the patient was admitted to.
METHODS
Over the course of 12 months, the discharges of all 1643 patients of two surgical intensive care units of a large academic medical center were analyzed. Delay in minutes and reasons were recorded and translated into financial figures. A univariate logistic regression model was developed to evaluate the impact of length of stay at the ICU, age, gender, subspecialty and specific ICU on the delay of transfer. In a next step, significant factors of the univariate logistic regression were incorporated into a multivariate regression model.
RESULTS
In 326 out of 1312 patients ready for discharge (24.8%), the transfer to the floor was delayed. Time of delay for all patients added up to a total of 265,691 min in 1 year. The application of the internal cost allocation, in which 1 min corresponds to 0.75 Euro cents, led to costs of 199,268 Euros (~ $240,000) for the study period. In 91.7% of the cases, the reason for the delay was the lack of an available or appropriate bed on the regular ward. Multivariate regression analysis revealed that the type of department the patient is admitted to poses a significantly influencing factor for delayed discharge from the ICU.
CONCLUSION
Delay in discharge from the ICU is a common problem of economic relevance. The main reason is a lack of appropriate floor beds. Patients from certain specific departments are at a higher risk to be discharged with delay. A solution to this problem lies in the focus on the downstream units. A proper use of the scarce resources is to be pursued because of ethical as well as economic reasons in an increasingly aging population.
背景
重症监护病房（ICU）的容量是医院稀缺而宝贵的资源。因此，最佳入住率和详细的入住规划非常重要。大多数文献都涉及 ICU 的收治，而只有少数文献讨论 ICU 的出院。具体来说，从 ICU 转出的延迟会导致床位短缺，危及紧急患者的治疗，并导致治疗质量下降和经济损失。本研究检查了 ICU 出院延迟的发生率、成本和原因，并分析了患者入院科室的影响。
方法
在 12 个月的时间里，分析了一家大型学术医疗中心的两个外科重症监护病房的 1643 名患者的出院情况。记录了分钟的延迟和原因，并将其转化为财务数字。建立了单变量逻辑回归模型，以评估 ICU 入住时间、年龄、性别、亚专科和特定 ICU 对转移延迟的影响。在下一步中，将单变量逻辑回归的显著因素纳入多变量回归模型。
结果
在 1312 名准备出院的患者中，有 326 名（24.8%）的转科延迟。所有患者的延迟时间加起来，在 1 年内总共为 265691 分钟。应用内部成本分配法，1 分钟对应 0.75 欧分，导致研究期间的费用为 199268 欧元（约合 24 万美元）。在 91.7%的情况下，延迟的原因是普通病房没有可用或合适的床位。多变量回归分析显示，患者入院科室的类型是 ICU 延迟出院的一个显著影响因素。
结论
从 ICU 出院延迟是一个具有经济相关性的常见问题。主要原因是缺乏合适的病房床位。来自某些特定科室的患者更有可能延迟出院。解决这个问题的办法在于关注下游科室。在人口老龄化的情况下，出于伦理和经济原因，应合理利用稀缺资源。
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