Association between strained ICU capacity and healthcare costs in Canada: A population-based cohort study

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

doi:10.1016/j.jcrc.2019.02.025

Cited by 17 publications

(23 citation statements)

References 49 publications

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“…16 For patients with multiple ICU admissions, only the rst admission was analyzed. The included ICUs were nine mixed medical/surgical units with a median [IQR] of 24 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] beds. Two units were classi ed as academic/quaternary, two were academic/tertiary units, and ve were community/metropolitan units ( Table 1).…”

Section: Study Design Setting and Populationmentioning

confidence: 99%

“…The eCritical Alberta system provides high-quality data due to rigorous data quality assurance and auditing processes and has been used by our team previously in health services research. 4,[18][19][20][21] There were no missing data elements for our primary exposure and outcome (afterhours discharge and hospital mortality, respectively). Missing data for individual variables were <3% and were not replaced or imputed.…”

Section: Data Sourcesmentioning

confidence: 99%

See 1 more Smart Citation

Association between Afterhours Discharge from the Intensive Care Unit and Hospital Mortality: A Multi-Centre Retrospective Cohort Study

Hall

Wang

Zuege

et al. 2020

Preprint

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Background: There is conflicting evidence on the association between afterhours discharge from the intensive care unit (ICU) and hospital mortality. We examined the effects of afterhours discharge, including the potential effect of residual organ dysfunction, on hospital mortality in a large integrated health region. Methods: We performed a multi-centre retrospective cohort study of 10,463 adults discharged from nine mixed medical/surgical ICUs in Alberta from June 2012 to December 2014. We applied a two-stage modelling strategy to investigate the association between afterhours discharge (19:00h to 07:59h) and post-ICU hospital mortality. We applied mixed-effect multi-variable linear regression to assess the relationship between discharge organ dysfunction and afterhours discharge. We then applied mixed-effect multi-variable logistic regression to evaluate the direct, indirect and integrated associations of afterhours discharge on hospital mortality and hospitalization duration. Results: Of 10,463 patients, 23.7% (n=2,480) were discharged afterhours, of which 27.4% occurred on a holiday or weekend. This varied significantly by ICU size, type, and site. Patients discharged afterhours were more likely medical admissions, had greater multi-morbidity and illness acuity. Greater SOFA score in the 72 hours prior to discharge was not associated with afterhours discharge; however, was associated with hospital mortality (adjusted-OR 1.23; 95%CI,1.18-1.28). Afterhours discharge was associated with higher hospital mortality (adjusted-OR 1.19; 95%CI, 1.01-1.39), increased hospital stay (adjusted-OR 1.10; 95%CI,1.09-1.11) and increased post-ICU stay (adjusted-OR 1.16; 95%CI,1.14-1.17).Conclusions: Afterhours discharge is common, occurring in 1 in 4 discharges, and is widely variable across ICUs. Patients discharged afterhours have greater risk of hospital mortality and prolonged hospitalization.

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Section: Study Design Setting and Populationmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

Association between Afterhours Discharge from the Intensive Care Unit and Hospital Mortality: A Multi-Centre Retrospective Cohort Study

Hall

Wang

Zuege

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The ICU Capacity Strain program explored issues related to strained ICU capacity across Alberta, with the goal of improving access and efficiency in ICUs and ultimately quality of care and outcomes. 2,6 The Evidence-Care Gaps program aimed to improve patient care by closing measurable gaps in evidence-based care. 5,8,9 Researchers gathered patient, family and interprofessional feedback from across Alberta, and reconciled 5 priority areas, including delirium screening, early mobilization, family presence and effective communication, and transitions in care.…”

Section: Information Infrastructure Ensures a Learning Health Systemmentioning

confidence: 99%

“…A single ICU day costs $3592, which extrapolates to about $377 million annually in expenditures for ICU services in the province. 1,2 As the population ages and medical care advances, demand for ICU care is expected to rise.…”

mentioning

confidence: 99%

Critical Care Strategic Clinical Network

Bowker

Stelfox

Bagshaw

2019

CMAJ

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“… 9 Avoidable time in the ICU has been defined as the portion of a total ICU stay accounted for by avoidable delay in ICU discharge. 10 The aim of our study was to describe the population-based incidence of avoidable time in the ICU and evaluate the association between avoidable time and health care costs and patient outcomes. We hypothesized that delays in ICU discharge would be common and would be associated with adverse outcomes and excess costs to the health care system.…”

Section: Introductionmentioning

confidence: 99%