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. 2014 Sep;42(9):2037-41.
doi: 10.1097/CCM.0000000000000401.

Relationship between ICU bed availability, ICU readmission, and cardiac arrest in the general wards

James A Town  1 , Matthew M Churpek, Trevor C Yuen, Michael T Huber, John P Kress, Dana P Edelson
Affiliations

Relationship between ICU bed availability, ICU readmission, and cardiac arrest in the general wards

James A Town et al. Crit Care Med. 2014 Sep.

Abstract

Objective: The decision to admit a patient to the ICU is complex, reflecting patient factors and available resources. Previous work has shown that ICU census does not impact mortality of patients admitted to the ICU. However, the effect of ICU bed availability on patients outside the ICU is unknown. We sought to determine the association between ICU bed availability, ICU readmissions, and ward cardiac arrests.

Design: In this observational study using data collected between 2009 and 2011, rates of ICU readmission and ward cardiac arrest were determined per 12-hour shift. The relationship between these rates and the number of available ICU beds at the start of each shift (accounting for census and nursing capacity) was investigated. Grouped logistic regression was used to adjust for potential confounders.

Setting: Five specialized adult ICUs comprising 63 adult ICU beds in an academic medical center.

Patients: Any patient admitted to a non-ICU inpatient unit was counted in the ward census and considered at risk for ward cardiac arrest. Patients discharged from an ICU were considered at risk for ICU readmission.

Interventions: None.

Measurements and main results: Data were available for 2,086 of 2,190 shifts. The odds of ICU readmission increased with each decrease in the overall number of available ICU beds (odds ratio = 1.06; 95% CI, 1.00-1.12; p = 0.03), with a similar but not statistically significant association demonstrated in ward cardiac arrest rate (odds ratio = 1.06; 95% CI, 0.98-1.14; p = 0.16). In subgroup analysis, the odds of ward cardiac arrest increased with each decrease in the number of medical ICU beds available (odds ratio = 1.26; 95% CI, 1.06-1.49; p = 0.01).

Conclusions: Reduced ICU bed availability is associated with increased rates of ICU readmission and ward cardiac arrest. This suggests that systemic factors are associated with patient outcomes, and flexible critical care resources may be needed when demand is high.

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Figures

Figure 1
Figure 1
Adjusted Intensive Care Unit (ICU) readmission rate by combined ICU bed availability, n = number of 12-hour shifts, p = 0.03.
Figure 2
Figure 2
Odds ratios and 95% confidence intervals for ICU readmission and ward cardiac arrest per unit decrease in ICU bed availability using grouped logistic regression and adjusted for academic year, season, time of day, and day of week. The odds ratio for ward cardiac arrest was also calculated for subgroups of available Medical ICU (MICU) and non-MICU beds. *p<0.05
Figure 3
Figure 3
Ward cardiac arrest rate by combined ICU bed availability, n = number of 12-hour shifts, p = 0.16.
Figure 4
Figure 4
Ward cardiac arrest rate by medical ICU (MICU) bed availability, n = number of 12-hour shifts, p = 0.01.
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