Boarding ICU patients: Are our rounding practices subpar?

Area of Science:

• Critical Care Medicine
• Surgical Outcomes
• Healthcare Operations

Background:

• Patients in Surgical Intensive Care Units (SICU) experience higher complication rates when
• boarding
• in non-designated ICUs.
• This study investigates differences in ICU rounding practices based on patient location.

Purpose of the Study:

• To determine if ICU rounding practices differ for Surgical Intensive Care Unit patients housed in their home ICU versus boarding in other ICUs.
• To identify factors influencing the duration and quality of patient-provider interactions during ICU rounds.

Main Methods:

• Observational study of SICU rounds at an academic quaternary medical center.
• Recorded individual patient rounding time, order of appearance, and patient demographics.
• Utilized multivariable regression analysis to compare patient groups.

Main Results:

• Boarded patients were seen for shorter durations and often at the end of rounds.
• Non-boarders were older, had higher APACHE II scores, and were more likely to be mechanically ventilated.
• Factors predicting increased rounding time included not boarding, older age, higher APACHE II scores, vasopressor use, and positive pressure ventilation.

Conclusions:

• Surgical ICU patients boarding in non-preferred units receive less bedside attention.
• Boarding is associated with increased reliance on telephone communication and reduced direct provider interaction.
• Current rounding practices may disadvantage boarded SICU patients, potentially impacting care quality.