University of British Columbia, Vancouver, BC, Canada.
Vancouver Coastal Health, Vancouver, BC, Canada.
Can J Anaesth. 2020 Oct;67(10):1359-1370. doi: 10.1007/s12630-020-01762-w. Epub 2020 Jul 27.
There is a paucity of evidence evaluating whether intensive care unit (ICU) discharge occupancy is associated with clinical outcomes. It is unknown whether increased discharge occupancy leads to greater afterhours discharges and downstream consequences. We explore the association between ICU discharge occupancy and afterhours discharges, 72-hr readmission, and 30-day mortality.
This single-centre, historical cohort study included all patients discharged from the Vancouver General Hospital ICU between 5 April 2010 and 13 September 2017. Data were obtained from the British Columbia Critical Care Database. Occupancy was defined as the number of ICU bed hours utilized divided by the available bed hours for that day. Any discharge between 22:00 and 6:59 was considered afterhours. Logistic regression models adjusting for important covariates were constructed.
We included 8,862 ICU discharges representing 7,288 individual patients. There were 1,180 (13.3%) afterhours discharges, 408 (4.6%) 72-hr readmissions, and 574 (6.5%) 30-day post-discharge deaths. Greater discharge occupancy was associated with afterhours discharges (per 10% increase: adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.03 to 1.20; P = 0.005). Discharge occupancy was not associated with 72-hr readmission (per 10% increase: aOR, 0.97; 95% CI, 0.87 to 1.09; P = 0.62) or 30-day mortality (per 10% increase: aOR, 1.05; 95% CI, 0.95 to 1.16; P = 0.32). Afterhours discharge was not associated with 72-hr readmission (aOR, 1.15; 95% CI, 0.86 to 1.54; P = 0.34) or 30-day mortality (aOR, 1.05; 95% CI, 0.82 to 1.36; P = 0.69).
Greater ICU discharge occupancy was associated with a significant increase in afterhours discharges. Nevertheless, neither discharge occupancy nor afterhours discharge were associated with 72-hr readmission or 30-day mortality.
评估重症监护病房（ICU）出院占用率与临床结局之间的关系的证据很少。尚不清楚增加出院占用率是否会导致更多的非工作时间出院和下游后果。我们探讨了 ICU 出院占用率与非工作时间出院、72 小时内再入院和 30 天死亡率之间的关系。
这是一项单中心的历史队列研究，纳入了 2010 年 4 月 5 日至 2017 年 9 月 13 日期间从温哥华总医院 ICU 出院的所有患者。数据来自不列颠哥伦比亚省重症监护数据库。入住率定义为 ICU 床位使用小时数除以当天可用床位小时数。任何在 22:00 至 6:59 之间的出院都被视为非工作时间出院。构建了调整重要协变量的 logistic 回归模型。
我们纳入了 8862 例 ICU 出院患者，代表了 7288 名个体患者。其中 1180 例（13.3%）为非工作时间出院，408 例（4.6%）为 72 小时内再入院，574 例（6.5%）为 30 天出院后死亡。较高的出院入住率与非工作时间出院相关（每增加 10%：调整后的优势比 [aOR]，1.12；95%置信区间 [CI]，1.03 至 1.20；P = 0.005）。出院入住率与 72 小时内再入院（每增加 10%：aOR，0.97；95% CI，0.87 至 1.09；P = 0.62）或 30 天死亡率（每增加 10%：aOR，1.05；95% CI，0.95 至 1.16；P = 0.32）无关。非工作时间出院与 72 小时内再入院（aOR，1.15；95% CI，0.86 至 1.54；P = 0.34）或 30 天死亡率（aOR，1.05；95% CI，0.82 至 1.36；P = 0.69）无关。
较高的 ICU 出院入住率与非工作时间出院显著增加相关。然而，无论是出院入住率还是非工作时间出院都与 72 小时内再入院或 30 天死亡率无关。
