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. 2025 Apr 1;53(4):e817-e828.
doi: 10.1097/CCM.0000000000006592. Epub 2025 Feb 7.

The Association of ICU Acuity and Organizational Factors With Outcomes of Low-Risk Patients

Emmanuel S Salgueiro  1   2 , Pedro Kurtz  3   4   5 , Lunna P Borges  6 , Leonardo S L Bastos  7 , Fernando G Zampieri  8 , Gaston Burghi  9 , Ulisses O Melo  10 , Thiago D Corrêa  11 , Samantha L S de Almeida  12 , Fernando V C de Marco  13 , Marcelo O Maia  14 , Victor S Cravo  2 , Laerte Pastore Jr  15 , Flávio G R de Freitas  16 , Marcelo S Santino  17 , Saulo F Saturnino  18 , Thiago C Lisboa  19 , José R A de Azevedo  20 , Pedro A Varaschin  21 , Viviane C Veiga  22 , Marcus A Ferez  23 , Márcio M Boniatti  24 , Marcelo F Rabahi  25 , Flavia R Machado  26 , Aline R S Antunes  3 , Grazielle V Ramos  3 , Fernando A Bozza  3   27 , Jorge I F Salluh  1   3 , Nelson Spector  1 , Marcio Soares  1   3 ; Organizational CHaractEriSTics in cRitical cAre (ORCHESTRA) Study Investigators
Collaborators, Affiliations

The Association of ICU Acuity and Organizational Factors With Outcomes of Low-Risk Patients

Emmanuel S Salgueiro et al. Crit Care Med. .

Abstract

Objective: Outcomes of low-risk patients may be affected by the overall acuity of the ICU to which they were admitted. Studies addressing this topic are very scarce and the underlying mechanisms supporting this association remain incompletely understood. Here, we investigated the effects of ICU acuity (defined as the mean Simplified Acute Physiology Score 3 of all admitted patients in the bimester in which a given patient was admitted) and organizational factors on the outcomes of patients with a low risk of dying admitted to ICUs.

Design: Retrospective cohort study.

Setting: One hundred and thirty-four ICUs from Brazil and Uruguay.

Patients: All low-risk (defined as a Simplified Acute Physiology Score 3 probability of death < 3%) patients admitted between 2016 and 2018.

Interventions: None.

Measurements and main results: The primary outcome was hospital mortality; secondary outcomes were ICU mortality, and ICU and hospital lengths of stay (LOS). ICU acuity was evaluated as a continuous variable. Multilevel multivariable regression analyses were used to explore the association between ICU acuity, organizational characteristics, and outcomes. Of 285,553 patients, 69,675 (24.4%) were considered low risk. Elective surgeries (66.2%) were the main admission reason. In the models adjusted for patient- and ICU-level characteristics, ICU acuity was not associated with hospital mortality (odds ratio [OR] = 1.095 [0.942-1.274]) and all secondary outcomes. These results were consistent in sensitivity analyses. The presence of dedicated pharmacists in the ICU (OR = 0.531 [0.365-0.773]) and the number of implemented clinical protocols (OR = 0.817 [0.688-0.970]) were independently associated with lower hospital mortality. Clinical protocols were also associated with shorter ICU and hospital LOS.

Conclusions: ICU acuity was not associated with outcomes in low-risk patients. Appropriate multidisciplinary staffing coupled with adherence to best clinical practices are essential to optimize efficiency and minimize variability of care for this population.

Keywords: intensive care unit acuity; low-risk patients; mortality; organization; outcomes.

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Conflict of interest statement

Dr. Zampieri received funding from Bactiguard Sweden and Baxter. Dr. Soares received funding from the National Council for Scientific and Technological Development (CNPq) (302257/2022-5), the Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) (E-26/201.057/2022), and Epimed Solutions; received support for article research from CNPq, FAPERJ, and by departmental funds from the D’Or Institute for Research and Education. Drs. Soares and Salluh are founders and equity shareholders of Epimed Solutions, which commercializes the Epimed Monitor System, a cloud-based software for ICU management and benchmarking. Ms. Borges is an employee of Epimed Solutions. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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