How the high acuity unit changes mortality in the intensive care unit: a retrospective before-and-after study
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How the high acuity unit changes mortality in the intensive care unit: a retrospective before-and-after study Changement dans la mortalite´ aux soins intensifs graˆce a` l’unite´ de soins interme´diaires : une e´tude re´trospective d’impact . Donald E. G. Griesdale, MD, MPH . Gregory Haljan, MD . Anish R. Mitra, MD, MPH Ashley O’Donoghue, MA . Jennifer P. Stevens, MD, MS Received: 15 January 2020 / Revised: 19 May 2020 / Accepted: 20 May 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose High acuity units (HAU) are hospital units that provide patients with more acute care and closer monitoring than a general hospital ward but are not as resource intensive as an intensive care unit (ICU). Nevertheless, the impact of opening a HAU on ICU patient outcomes remains poorly defined. We investigated how the creation of a HAU impacted patient outcomes in the ICU. Methods This historical cohort study compared ICU patient in-hospital mortality, ICU length of stay (LOS), and hospital LOS before and after the creation of a HAU in
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01775-5) contains supplementary material, which is available to authorized users. A. R. Mitra, MD, MPH (&) Division of Critical Care Medicine, Department of Medicine, Surrey Memorial Hospital, Surrey, BC, Canada e-mail: [email protected] Department of Medicine and Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
a tertiary-care hospital with a medical/surgical ICU between 1 January 2013 and 31 December 2017. Results Data from 4,380 patients (984 in the pre-HAU group and 3,396 in the post-HAU group) were analyzed. In this cohort of ICU patients, 360 (37%) died in the pre-HAU group before the creation of a HAU, and 1,074 (32%) died in the post-HAU group after the creation of a HAU. The creation of a HAU was associated with lower relative risk of in-hospital mortality (adjusted risk ratio, 0.80; 95% confidence interval [CI], 0.72 to 0.89; P \ 0.001). The creation of a HAU was also associated with reduced ICU and hospital LOS with a 12% increase in the rate of ICU discharge (adjusted sub-distribution hazard ratio [SHR], 1.12; 95% CI, 1.02 to 1.23; P = 0.02) and a 26% increase in the rate of hospital discharge (adjusted SHR, 1.26; 95% CI, 1.14 to 1.39; P \ 0.001), when accounting for the competing risk of death. Department of Medicine and Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada A. O’Donoghue, MA Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
Intensive Care Unit – Surrey Memorial Hospital, 13750, 96th Ave, Surrey, BC V3V 1Z2, Canada
J. P. Stevens, MD, MS Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA
D. E. G. Griesdale, MD, MPH Department of Medicine and Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
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