Division of Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, USA.
Division of General Internal Medicine, Geisinger Health System, Danville, PA, USA.
J Crit Care. 2020 Aug;58:48-55. doi: 10.1016/j.jcrc.2020.04.009. Epub 2020 Apr 15.
Hospital occupancy (HospOcc) pressures often lead to longer intensive care unit (ICU) stay after physician recognition of discharge readiness. We evaluated the relationships between HospOcc, extended ICU stay, and patient outcomes.
7-year retrospective cohort study of 8500 alive discharge encounters from 4 adult ICUs of a tertiary hospital. We estimated associations between i) HospOcc and ICU transfer delay; and ii) ICU transfer delay and hospital mortality.
Median (IQR) ICU transfer delay was 4.8 h (1.6-11.7), 1.4% (119) suffered in-hospital death, and 4% (341) were readmitted. HospOcc was non-linearly related with ICU transfer delay, with a spline knot at 80% (mean transfer delay 8.8 h [95% CI: 8.24, 9.38]). Higher HospOcc level above 80% was associated with longer transfer delays, (mean increase 5.4% per % HospOcc increase; 95% CI, 4.7 to 6.1; P < .001). Longer ICU transfer delay was associated with increasing odds of in-hospital death or ICU readmission (odds ratio 1.01 per hour; 95% CI 1.00 to 1.01; P = .04) but not with ICU readmission alone (OR 1.01 per hour; 95% CI 1.00 to 1.01, P = .14).
ICU transfer delay exponentially increased above a threshold hospital occupancy and may be associated with increased hospital mortality.
医院入住率（HospOcc）压力常常导致医生确认准备出院后 ICU 住院时间延长。我们评估了 HospOcc、ICU 停留时间延长与患者预后之间的关系。
对一家三级医院 4 个成人 ICU 的 8500 例存活出院患者进行了 7 年的回顾性队列研究。我们估计了 i）HospOcc 与 ICU 转科延迟之间的关联；ii）ICU 转科延迟与院内死亡率之间的关联。
ICU 转科延迟的中位数（IQR）为 4.8 小时（1.6-11.7），1.4%（119）发生院内死亡，4%（341）再次入院。HospOcc 与 ICU 转科延迟呈非线性相关，在 80%处有一个样条结（平均转科延迟 8.8 小时[95%CI：8.24，9.38]）。超过 80%的 HospOcc 水平越高，转科延迟越长（每增加 1%HospOcc，平均增加 5.4%；95%CI，4.7 至 6.1；P<0.001）。较长的 ICU 转科延迟与院内死亡或 ICU 再次入院的几率增加相关（每小时增加 1.01；95%CI 1.00 至 1.01；P=0.04），但与 ICU 再次入院无关（每小时增加 1.01；95%CI 1.00 至 1.01，P=0.14）。
ICU 转科延迟在超过一个阈值的医院入住率时呈指数增加，可能与医院死亡率增加有关。
