Reduced ICU bed availability can lead to less-aggressive patient care
by Sanjay Galhotra, MD, MPH, Paul Martin, MD, MPH, Martina Stehlikova, MD, Claire Brown, MD, Valentyna Goloborodko, MD, MPH, Andrea Porovecchio, MD, William Southern, MD, MPH, SFHM, Albert Einstein College of Medicine
Clinical question: Does intensive-care-unit (ICU) bed availability impact outcomes for hospitalized patients with sudden clinical deterioration?
Background: ICU beds are a scarce resource, and their availability might affect the care delivered to hospitalized patients who deteriorate clinically.
Study design: Retrospective cohort analysis.
Setting: Three hospitals in Calgary, Alberta.
Synopsis: This study analyzed data for a retrospective cohort of 3,494 hospitalized patients who had a sudden clinical deterioration triggering a medical emergency team. The associations between ICU bed availability and three outcomes—likelihood of ICU admission, change in goals of care (from "resuscitative" to either "medical" or "comfort"), and hospital mortality—were examined.
Reduced ICU bed availability was associated with decreased likelihood of ICU admission and increased likelihood of a change in goals of care. When more than two ICU beds were available, 21.4% of patients with a clinical deterioration were admitted to the ICU, compared with 11.6% and 14.5% if zero or one bed was available. When more than two ICU beds were available, 8.5% of patients had a change in their goals of care, compared with 14.9% of patients who had a change in goals of care when zero ICU beds were available. ICU bed availability was not associated with in-hospital mortality.
Bottom line: Reduced ICU bed availability is associated with decreased likelihood of ICU admission and increased likelihood of changing goals of care to a less aggressive strategy.
Citation: Stelfox HT, Hemmelgarn BR, Bagshaw SM, et al. Intensive care unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med. 2012;172:467-474.
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