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The Impact of Geographic Location on Patient Outcomes Within a Single Institution's ICU System FREE TO VIEW

Choua Thao; Maria Luraschi; Hidenobu Shigemitsu; Matthew Schreiber, MD
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Pulmonary/Critical Care, University of Nevada School of Medicine, Las Vegas, NV

Chest. 2014;146(4_MeetingAbstracts):497A. doi:10.1378/chest.1994787
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SESSION TITLE: Outcomes/Quality Control Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: In many hospitals, there is a high demand for medical ICU (MICU) beds, but with limited resources, tactics are developed to accommodate these patients. Commonly patients are shifted (i.e. boarding) to a secondary unit in times of limited MICU bed availability. Often, this secondary “boarding-unit” is located within the same hospital but is geographically distinct. There are few studies done to evaluate the impact of admission to the MICU versus boarding patients in another unit while under the care of the same MICU team (i.e. length of stay and mortality). We hypothesize that patient outcomes may be impacted by patient location, between intensive care units, independent of the patient care team.

METHODS: We conducted a prospective observational cohort study analyzing consecutive admissions to the University of Nevada School of Medicine MICU teaching service at University Medical Center in Las Vegas, NV between 2/1/13 and 3/1/14. Subjects were stratified by geographic location between the MICU tower and those boarding in the Cardiac ICU tower (connected adjacent building). Demographic, clinical, and outcome data was collected and analyzed using Chi2, ANOVA and descriptive statistics where appropriate.

RESULTS: 2126 subjects were observed with a mean age of 53. 58% were male with a mean (median) length of stay of 4.0 (2.0) days and mean mortality of 10.4%. When stratified by location, significant differences were seen between the MICU and “boarding unit” for both length of stay (3.7 vs. 5.4 days, p<0.001) and all mortality (6.4 vs. 9.6%, p=0.03).

CONCLUSIONS: Independent of the patient care team, length of stay and mortality are associated with geographic location (primary ICU unit vs. boarding in a secondary unit).

CLINICAL IMPLICATIONS: Patient outcomes may benefit from consideration of geographic location within a hospital’s critical care system. The impact on patient hospital and patient outcomes may be independent of physician staffing models.

DISCLOSURE: The following authors have nothing to disclose: Choua Thao, Maria Luraschi, Hidenobu Shigemitsu, Matthew Schreiber

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