Assessment of Costs of Avoidable Delays in Intensive Care Unit Discharge

Bagshaw, Sean M.; Tran, Dat T.; Opgenorth, Dawn; Wang, Xiaoming; Zuege, Danny J.; Ingolfsson, Armann; Stelfox, Henry T.; Thanh, Nguyen Xuan

doi:10.1001/jamanetworkopen.2020.13913

Cited by 22 publications

(21 citation statements)

References 23 publications

(96 reference statements)

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“…In addition, the substantial decline in avoidable time prior to ICU discharge (i.e., reduced ICU exit block) observed during the lockdown epoch can be viewed as better efficiency (i.e., patient flow) and utilization of constrained ICU resources. Implementation of policies to reduce exit block and to facilitate more timely transition of patients to the ward, and strategic expansion of ward-bed capacity could realize considerable improvements in efficiency and cost savings (5).…”

Section: Implications For Clinicians and Policymentioning

confidence: 99%

Association Between Pandemic Coronavirus Disease 2019 Public Health Measures and Reduction in Critical Care Utilization Across ICUs in Alberta, Canada

Bagshaw¹,

Zuege²,

Stelfox

et al. 2021

Critical Care Medicine

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The coronavirus disease 2019 pandemic has disrupted critical care services across the world. In anticipation of surges in the need for critical care services, governments implemented "lockdown" measures to preserve and create added critical care capacity. Herein, we describe the impact of lockdown measures on the utilization of critical care services and patient outcomes compared with nonlockdown epochs in a large integrated health region. DESIGN:This was a population-based retrospective cohort study.

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Section: Implications For Clinicians and Policymentioning

confidence: 99%

Association Between Pandemic Coronavirus Disease 2019 Public Health Measures and Reduction in Critical Care Utilization Across ICUs in Alberta, Canada

Bagshaw¹,

Zuege²,

Stelfox

et al. 2021

Critical Care Medicine

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“…Yet some subsets of population are at higher risk for more severe disease which may require hospitalization and/or intensive care unit admission due to complications such as pneumonia or acute respiratory distress. It is well known that the elderly (≥65 years of age) have the highest risk of increased morbidity including respiratory failure, and mortality; It is estimated that over 60% of all seasonal-influenza-related hospitalizations and 90% of seasonal-influenza-related deaths each year occur in the elderly [2,[3][4][5][6][7] in Europe [9], suggest that vaccination offered only slight protection for severe outcome due to this fact and because there was a high proportion of elderly hospitalizations (79.1%) and that older age is associated with a lower ICU admission [10].Data on the inverse relation between age and ICU admission has also been pointed out by other authors who found higher rate of ICU admission among SHCIC at 15-64 y [11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…Severity implies not only complications such as pneumonia, severe respiratory distress, multiorgan failure and death but also implies intensive care unit (ICU) admission because of the complications derived from influenza infection. ICU admission has been associated with adverse outcomes and excess costs to the health care system especially with longer hospital stays (LOS) [3].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Influenza Vaccination in Hospitalized Cases in Catalonia During the 2017-2018 Season

Acosta¹,

Soldevila²,

Torner³

et al. 2020

Preprint

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Seasonal flu is a common cause of hospital admission, especially in populations with comorbidities or extreme ages. The objective was to investigate the effectiveness of influenza vaccination in hospitalized laboratory confirmed influenza cases (HLCI). A retrospective case-to-case study of HLCI adults in Catalonia, during the 2017-2018 season was carried out. Differences in means, proportions, factors associated with vaccine effectiveness (VE) and intensive care unit (ICU) were assessed by t-test, Chi-squared test, logistic regression and multivariate logistic regression, accordingly. A total of 1414 HLCI aged 18 years and older were included in the analysis, 465 (33%) vaccinated, (of these 94% were ≥ 60 yrs.), 804 (56.9%) were men, 61% were type B influenza and 15.1% required ICU admission. An age of 60 or older was associated with lower ICU admission (OR 0.44; 95%CI 0.32-0.61; &lt;0.001). Mean length of hospital stay (LOS) and ICU stay (LICS) did not differ significantly between vaccinated and unvaccinated, although ICU admission proportion did (11.2% in vaccinated vs. 17.1% in unvaccinated). A longer hospital stay was observed in those patients being admitted to ICU being 22.4 (SD 20.3) days vs 11.1(SD14.4) days (p&lt;0,001) for those not admitted to ICU. Being vaccinated avoids ICU admission, aOR of 69% (95%CI 0.49-0.99; 0.04). Considering types A and B jointly, VE to avoid ICU admission was 31% (95%CI 1-52). For type B virus only, VE was 25% (95%CI 18-51). Annual influenza vaccination can reduce the need of admission to ICU in cases of laboratory confirmed influenza virus infections. A shorter mean hospital stay was observed in vaccinated cases, but the result is not statistically significant.

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“…Severity implies not only complications such as pneumonia, severe respiratory distress, multiorgan failure and death, but also intensive care unit (ICU) admission due to the complications of influenza infection. ICU admission is associated with adverse outcomes and excess health costs, especially longer hospital stays (LOS) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Persons aged ≥65 years have the highest risk of increased morbidity including respiratory failure and mortality. It is estimated that >60% of all seasonal influenza-related hospitalizations and 90% of seasonal influenza-related deaths each year occur in older people [ 2 , 3 , 4 , 5 , 6 , 7 ]. Influenza vaccination can reduce influenza illness and, in turn, the primary healthcare workload, occupational and school absenteeism and influenza-related hospitalizations and deaths, especially in older people and those with underlying medical conditions.…”

Section: Introductionmentioning

confidence: 99%

Influenza Vaccine Effectiveness in Preventing Severe Outcomes in Patients Hospitalized with Laboratory-Confirmed Influenza during the 2017–2018 Season. A Retrospective Cohort Study in Catalonia (Spain)

Acosta

Soldevila

Torner

et al. 2021

Viruses

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Seasonal influenza is a common cause of hospital admission, especially in older people and those with comorbidities. The objective of this study was to determine influenza vaccine effectiveness (VE) in preventing intensive care admissions and shortening the length of stay (LOS) in hospitalized laboratory-confirmed influenza cases (HLCI) in Catalonia (Spain). A retrospective cohort study was carried out during the 2017–2018 season in HLCI aged ≥18 years from 14 public hospitals. Differences in means and proportions were assessed using a t-test or a chi-square test as necessary and the differences were quantified using standardized effect measures: Cohen’s d for quantitative and Cohen’s w for categorical variables. Adjusted influenza vaccine effectiveness in preventing severity was estimated by multivariate logistic regression where the adjusted VE = (1 − adjusted odds ratio) · 100%; adjustment was also made using the propensity score. We analyzed 1414 HLCI aged ≥18 years; 465 (33%) were vaccinated, of whom 437 (94%) were aged ≥60 years, 269 (57.8%) were male and 295 (63.4%) were positive for influenza type B. ICU admission was required in 214 (15.1%) cases. There were 141/1118 (12.6%) ICU admissions in patients aged ≥60 years and 73/296 (24.7%) in those aged <60 years (p < 0.001). The mean LOS and ICU LOS did not differ significantly between vaccinated and unvaccinated patients. There were 52/465 (11.2%) ICU admissions in vaccinated cases vs. 162/949 (17.1%) in unvaccinated cases. Patients admitted to the ICU had a longer hospital LOS (mean: 22.4 [SD 20.3] days) than those who were not (mean: 11.1 [SD 14.4] days); p < 0.001. Overall, vaccination was associated with a lower risk of ICU admission. Taking virus types A and B together, the estimated adjusted VE in preventing ICU admission was 31% (95% CI 1–52; p = 0.04). When stratified by viral type, the aVE was 40% for type A (95% CI -11–68; p = 0.09) and 25% for type B (95% CI -18–52; p = 0.21). Annual influenza vaccination may prevent ICU admission in cases of HLCI. A non-significantly shorter mean hospital stay was observed in vaccinated cases. Our results support the need to increase vaccination uptake and public perception of the benefits of influenza vaccination in groups at a higher risk of hospitalization and severe outcomes.

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Assessment of Costs of Avoidable Delays in Intensive Care Unit Discharge

Abstract: This population-based cohort study describes the epidemiology and health care costs associated with potentially avoidable delays in intensive care unit discharge among adult patients in a large integrated health care system.

Cited by 22 publications

References 23 publications

Association Between Pandemic Coronavirus Disease 2019 Public Health Measures and Reduction in Critical Care Utilization Across ICUs in Alberta, Canada

Association Between Pandemic Coronavirus Disease 2019 Public Health Measures and Reduction in Critical Care Utilization Across ICUs in Alberta, Canada

Effectiveness of Influenza Vaccination in Hospitalized Cases in Catalonia During the 2017-2018 Season

Influenza Vaccine Effectiveness in Preventing Severe Outcomes in Patients Hospitalized with Laboratory-Confirmed Influenza during the 2017–2018 Season. A Retrospective Cohort Study in Catalonia (Spain)

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