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Interventions to circumvent intensive care access block: a retrospective 2-year study across metropolitan Melbourne
Graeme J Duke1, Michael D Buist, David Pilcher
1Critical Care Department, Northern Hospital, Melbourne, VIC, Australia. graeme.duke@nh.org.au
Objectives:
To measure the prevalence of interventions used to circumvent intensive care access block and to estimate the attributable mortality and additional hospital bed-days associated with them.
Design And Setting:
Retrospective observational study of 11 adult public hospital intensive care units (ICUs) in Melbourne, Victoria, July 2004 - June 2006.
Main Outcome Measures:
Prevalence of five interventions in response to access block; attributable fatalities and/or increased length of stay associated with each.
Results:
21 896 ICU admissions and 3039 inhospital deaths (13.9%) were screened. All hospitals reported ICU access block. There were 6787 interventions for access block (mean, 9.3/day) -- 4070 (18.6% of admissions) instances of after-hours step-down from an ICU to a low-acuity ward; 1115 (5.1%) delays in an emergency department > 8 hours; 895 (4.1%) postponed major surgeries; 487 (2.2%) interhospital transfers; and 220 (1.0%) instances of premature cessation of intensive care. Based on published risk estimates, these interventions may have resulted in 91.1 (95% CI, 34.7-147.2) attributable deaths and 4368 (95% CI, 333-10 050) additional hospital bed-days each year.
Conclusions:
Intensive care access block is frequent, and measures to circumvent it increase mortality and length of stay. Further study of the health and financial implications of access block are warranted.
