患者フローセンターの集中治療室患者退院および患者転帰に対する有効性の評価：後向き定量的コホート研究

Xia Jin¹, Shailesh Bihari², Steven Galluccio³

¹Intensive Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia; Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia; College of Nursing and Health Sciences, Flinders University, South Australia, Australia.

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses

|December 19, 2025

要旨

Background:

There is growing interest in centralised patient flow centres (PFCs) designed to optimise hospital patient flow and improve resource efficiency. However, the specific impact of such centres on intensive care unit (ICU) patient flow and patient outcomes is unknown.

Objective:

The objective of this study was to evaluate the effects of ICU discharge efficiency and patient outcomes before and after implementation of a PFC.

Methods:

A retrospective cohort study was conducted at a tertiary ICU in Australia, including patients admitted to the ICU between January 1st, 2018, and December 31st, 2023. Data were extracted from the Australian and New Zealand Intensive Care Society Adult Patient Database. Primary outcomes were ICU discharge delay, after-hours discharge, and readmission to the ICU within 48 h of discharge. Secondary outcomes included ICU and hospital length of stay (LOS) and hospital mortality.

Results:

A total of 8 383 patients were included. Post implementation, a higher proportion of patients experienced ICU discharge delays (16.1%, n = 656, p = 0.05) and after-hours discharges (15.6%, n = 636, p < 0.001), without a significant change in the ICU readmission rate. After adjusting for confounders, patients in the post-PFC group had a higher risk for after-hours discharge than those in the pre-PFC group (odds ratio: 1.62, confidence interval: 1.41-1.87, p < 0.001). The implementation of the PFC was associated with lower hospital mortality (odds ratio: 0.72, confidence interval: 0.55-0.94, p < 0.05) and shorter hospital LOS (p = 0.05).

Conclusions:

An increase in the proportion of ICU discharge delays and after-hours discharges was observed following the PFC implementation, without an increase in ICU readmissions. Centralised coordination and improved visibility of patient flow through the hospital system could have contributed to reduced hospital LOS and mortality. Future studies must explore factors influencing the effectiveness of the PFC on ICU patient flow and evaluate the observed benefits by incorporating ICU access block measures.

キーワード:

時間外退院退院遅延病院死亡率集中治療室在院日数患者フローセンター再入院