Critical care medicine in the United States 2000–2005: An analysis of bed numbers, occupancy rates, payer mix, and costs*

Halpern, Neil A.; Pastores, Stephen M.

doi:10.1097/ccm.0b013e3181b090d0

Cited by 749 publications

(538 citation statements)

References 52 publications

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“…Although antibiotics were not predictors of mortality in the present study, delay in antimicrobial therapy has been associated with decreased survival in severe sepsis [22]. The importance of aggressive management at the ED becomes even clearer when one considers the frequent need to board patients at the ED due to the widespread shortage of ICU beds [19,23].…”

Section: Discussionmentioning

confidence: 55%

The impact of a delay in intensive care unit admission for community-acquired pneumonia

Phua¹,

Ngerng²,

Lim³

2010

European Respiratory Journal

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The primary objective of the present study was to evaluate the effect on hospital mortality of a delay in intensive care unit (ICU) admission for severe community-acquired pneumonia (CAP). The secondary objectives were to assess if such delays were associated with treatment variations by the emergency department (ED) and deterioration in the general wards, and to evaluate the prognostic ability of the Infectious Disease Society of America (IDSA)/ American Thoracic Society (ATS) minor criteria.We retrospectively compared patients who were admitted straight from the ED to the ICU (direct group, n554) and those who were first admitted from the ED to the general wards before ICU transfer (delayed group, n549), over 2.5 yrs.Even after excluding patients who required mechanical ventilation and/or vasopressors at the ED, delayed ICU admission was an independent predictor of hospital mortality (OR 9.61). The delayed group received fewer fluid boluses in the ED and rapidly deteriorated in the general wards. The presence of o3 IDSA/ATS minor criteria was associated with increased mortality in the delayed group.In conclusion, prompt recognition of severe CAP using the IDSA/ATS minor criteria, followed by aggressive management at the ED and direct ICU admission, are all crucial toward improving outcomes.

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Section: Discussionmentioning

confidence: 55%

The impact of a delay in intensive care unit admission for community-acquired pneumonia

Phua¹,

Ngerng²,

Lim³

2010

European Respiratory Journal

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“…With an increase in critical care usage (Halpern and Pastores 2010) and a relatively stagnant supply of ICU beds, it is no wonder that delays for patients awaiting ICU admission are growing. This paper will focus on the flow of patients from the ED into the ICU.…”

Section: Delays and The Ed-icu Interfacementioning

confidence: 99%

The Impact of Delays on Service Times in the Intensive Care Unit

Chan¹,

Farias

Escobar

2017

Management Science

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Mainstream queueing models are frequently employed in modeling healthcare delivery in a number of settings, and further used in making operational decisions for the same. The vast majority of these queueing models assume that the service requirements of a job are independent of the state of the queue upon its arrival. In a healthcare setting, this assumption is equivalent to ignoring the effects of delay experienced by a patient awaiting care. However, it is only natural to conjecture that long delays may have adverse effects on patient outcomes and can potentially lead to longer lengths of stay (LOS) when the patient ultimately does receive care. At a very coarse level, prior research confirms these natural conjectures. This work sets out to understand these delay issues from an operational perspective. In particular, using data of nearly 6,000 Emergency Department (ED) visits, we use an instrumental variable approach to empirically measure how congestion in the Intensive Care Unit (ICU) can lead to delays in boarding from the ED to the ICU and measure the impact on the patient's ICU LOS.Capturing these empirically observed effects in a queueing model is challenging as the effect introduces potentially long range correlations in service and inter-arrival times. As such, we consider the problem of how to incorporate these measured delay effects into a queueing model and characterize approximations to various quantities of interest when the service time of a job is adversely impacted by the delay experienced by that job. Our findings suggest that this delay effect can be substantial and ignoring it when using queueing models to model healthcare delivery systems may result in significant under-provisioning.

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“…There has been an increase in ICU beds, but this has not met the even greater increase in number of children needing those beds. 4 An expansion of the ICU and the development of an ICU stepdown unit could address the issue of bed space scarcity; however, the same issues will arise when the larger ICU and step-down units become full.…”

Section: Dr Wightman Respondsmentioning

confidence: 99%