A new study by Penn Medicine researchers published Oct. 1 in the Annals of Internal Medicine found that busy intensive care units (ICUs) discharge patients more quickly than they otherwise would and do so without adversely affecting patient outcomes – suggesting that low-value extensions of ICU stays are minimized during times of increased ICU capacity strain.
An expected growth in the number of patients requiring critical care resources combined with a projected shortage in critical care providers will likely result in ICUs operating under conditions of increasing strain, leading to increased competition for ICU beds among greater numbers of more seriously ill patients. Many fear that this strain on an ICU’s capacity to provide high quality care will result in patients spending shorter periods of time in the ICU and therefore experiencing worse health outcomes due to “rationing” of necessary critical care.
However, the new study, led by Jason Wagner, MD, MSHP, a senior fellow in the Division of Pulmonary, Allergy and Critical Care at the Perelman School of Medicine at the University of Pennsylvania, helps dispel the notion that resource-strained ICUs will ration critical care resources and negatively affect patient care, with findings that have important implications for planning U.S. critical care capacity. If bed crunches in the ICU cause reductions in the delivery of low-value ICU care for patients nearing ICU discharge without adversely affecting patients, it is conceivable that reductions in the number of U.S. ICU beds could yield considerable cost savings without reducing the quality of care.
In a retrospective analysis of over 200,000 patients from 155 ICUs in the United States between 2001 and 2008, the authors found that when ICUs were at their busiest, patients were discharged an estimated 6.3 hours sooner than they otherwise would be. Nonetheless, such patients experienced no increase in the odds of dying in the hospital, no greater overall length of hospital stay, and no decrease in the odds of ultimately going home. ICU capacity was measured by ICU census, number of new admissions, and the average acuity of the other patients in the ICU at the time of a patient's discharge.
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