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The Relationship Between ICU Patient Volume and Risk-Adjusted Mortality and Length of Stay FREE TO VIEW

Haala Rokadia*, MD; Esteban Walker, PhD; Rendell Ashton, MD; Jorge Guzman, MD
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Cleveland Clinic, Cleveland, OH

Chest. 2012;142(4_MeetingAbstracts):381A. doi:10.1378/chest.1390672
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SESSION TYPE: ICU Safety and Quality Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: In the current climate of policy reform, there is increased pressure to deliver cost-effective and safe medical care. It is important to determine how increased intensive care unit (ICU) patient volume affects patient outcomes, specifically mortality and length of stay (LOS). Aim: To evaluate the role of increased ICU patient volume on risk-adjusted ICU and hospital mortality and LOS.

METHODS: Methods: We performed a retrospective analysis of all patients admitted to the medical ICU (MICU) at our institution between January 2008-October 2011. We collected demographic, clinical, and admission/discharge information on each patient and calculated APACHE-IV scores. We calculated population data on weekly patient volumes, mortality rates, and LOS. Multivariate logistic and linear regression was used to assess these associations.

RESULTS: Results: 7848 patient encounters were available for analysis. The population had a mean age of 59.9(15.7) years, a balanced male/female ratio, and was predominantly Caucasian (67.2%). Admissions were predominantly from nursing floors (34.3%), hospital transfers (36.7%), and emergency department (18.4%). The MICU patient volume increased 3-fold over the course of the study period. The mean (SD) weekly patient volumes for 2008, 2009, 2010, and 2011 were 38(6), 57(6), 83(13), and 103(12) patients, respectively. In multivariate analysis, hospital and ICU mortality rates adjusted for APACHE-IV score decreased with increasing ICU weekly volumes (p<0.001 for both comparisons). Additionally, we found that increased ICU weekly volume was associated with shorter ICU LOS(p=0.0006) and shorter overall hospital LOS(p<0.0001).

CONCLUSIONS: Our study demonstrated that an increase in the ICU patient volume is associated with reduction in the risk-adjusted ICU mortality and overall inpatient mortality rate. In addition to mortality metrics, there was a significant reduction in ICU and in-hospital LOS with increasing ICU patient volume. Although mortality and length of stay are subject to unmeasured variables, our study demonstrated an association between higher ICU patient volumes and improved outcomes that lends itself to further study.

CLINICAL IMPLICATIONS: This suggests that rapidly expanding the patient volume in the ICU can be done safely and efficiently.

DISCLOSURE: The following authors have nothing to disclose: Haala Rokadia, Esteban Walker, Rendell Ashton, Jorge Guzman

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Cleveland Clinic, Cleveland, OH




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