Association between intensive care unit occupancy at discharge, afterhours discharges, and clinical outcomes: a historic
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REPORTS OF ORIGINAL INVESTIGATIONS
Association between intensive care unit occupancy at discharge, afterhours discharges, and clinical outcomes: a historical cohort study Association entre le taux d’occupation de l’unite´ de soins intensifs au moment du conge´, les conge´s donne´s durant la nuit, et les devenirs cliniques : une e´tude de cohorte historique Nicholas A. Fergusson, MSc . Steve Ahkioon, PhD . Najib Ayas, MD . Vinay K. Dhingra, MD . Dean R. Chittock, MD . Mypinder S. Sekhon, MD . Anish R. Mitra, MD . Donald E. G. Griesdale, MD, MPH Received: 21 February 2020 / Revised: 1 May 2020 / Accepted: 2 May 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose 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 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01762-w) contains supplementary material, which is available to authorized users. N. A. Fergusson, MSc University of British Columbia, Vancouver, BC, Canada S. Ahkioon, PhD Vancouver Coastal Health, Vancouver, BC, Canada N. Ayas, MD V. K. Dhingra, MD D. R. Chittock, MD M. S. Sekhon, MD A. R. Mitra, MD Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada D. E. G. Griesdale, MD, MPH (&) Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC V5Z 1M9, Canada e-mail: [email protected] Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
association between ICU discharge occupancy and afterhours discharges, 72-hr readmission, and 30-day mortality. Methods 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. Results 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 wi
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