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Analyzing the impact of long-term patients on ICU bed utilization
1Department of Anesthesiology and Critical Care Medicine, Hadassah-University Hospital, Jerusalem, Israel. Charles@hadassah.org.il
Objective:
To establish ways of defining long-term ICU patients and to develop methods of quantifying their impact on bed utilization.
Design:
Retrospective analysis of prospectively collected sample data.
Setting:
Two university hospital adult surgical ICUs.
Patients:
6,588 consecutive patients admitted over 8 years to ICU 1 and 2,913 patents admitted over 5 years to ICU 2.
Interventions:
None.
Measurements And Results:
Patients with uncommon but expected long stays were designated as long-term patients and those with exceptional and unexpected long stays were designated as outliers. Visualization of the length-of-stay frequency distributions revealed that the "tail" of the distributions began at a stay of about 10 days, and this was chosen as the threshold for long-term patients. A threshold of 30 days was chosen as the outlier threshold since only isolated patients stayed longer. The impact (long-term patients/total admissions) of long-term patients on bed utilization was assessed and year-to-year differences examined. Long-term patients staying at least 10 days used 2.7-5.0 bed-years.
Conclusions:
Long-term patients can have a major impact on ICU bed utilization. With 23-45% of the beds occupied by long-term patients, the availability of beds for short-stay patients is reduced. This is important in ICUs where efficient patient throughput is vital, so that beds are availability for both elective and emergency admissions.