International Journal for Quality in Health Care 16:149-155 (2004)
International Journal for Quality in Health Care vol. 16 no. 2 © International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved
The characteristics of very short stay ICU admissions and implications for optimizing ICU resource utilization: the Saudi experience
1 Department of Intensive Care and
3 Quality Management,
2 King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
Objective. Patients with very short stays (<24 hours) in intensive care units (ICUs) constitute a distinct group with a high turnover rate and a unique patient mix. Our aim was to study their characteristics with the aim of developing strategic approaches for better and more appropriate utilization of ICU resources.
Design. Prospective cohort study.
Setting. Adult medical/surgical ICU in a tertiary care teaching hospital.
Study participants. All admissions in an adult ICU from March 1999 to February 2001 and staying <24 hours were enrolled. Relevant data were collected on these patients, their course and outcome, and analyzed after categorizing patients according to: (i) the nature of admission; and (ii) risk of death (ROD) estimated by Mortality Probability Model II0.
Results. Patients staying <24 hours (n = 304) formed 27.8% of all ICU admissions, with an ICU mortality rate of 26.3%. Only 45.4% of them utilized ICU-specific procedures. Around one-third (32.6%) were elective admissions comprising younger patients, with a significantly lower prevalence of chronic illness, a lower ROD, and utilization of less ICU-specific procedures, with very few mortalities. When stratified using RODs into low-, intermediate-, and high-risk groups, significant differences were found with respect to age, nature of ICU admission, presence of chronic illness, utilization of ICU-specific procedures, having do-not-resuscitate (DNR) orders, length of ICU stay, and ICU and hospital outcomes.
Conclusions. Our study has provided crucial input for the study of strategic change towards more optimal utilization of scarce ICU resources. Implementing protocols to target ICU care to patients most likely to benefit, making DNR decisions early in the hospital stay, and operating an Intermediate Care Unit have been proposed as strategic approaches.
Keywords: do-not-resuscitate, intensive care, length of stay, resource utilization, risk of death
Address reprint requests to Yaseen Arabi MD FCCP, Deputy Chairman, Intensive Care Department (MC 1425), King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia. E-mail: arabi{at}ngha.med.sa
Accepted for publication November 24, 2003.