Analyzing the impact of long-term patients on ICU bed utilization.

Abstract

To establish ways of defining long-term ICU patients and to develop methods of quantifying their impact on bed utilization. Retrospective analysis of prospectively collected sample data. Two university hospital adult surgical ICUs. 6,588 consecutive patients admitted over 8 years to ICU 1 and 2,913 patents admitted over 5 years to ICU 2. None. Patients with uncommon but expected long stays were designated as long-term patients and those with exceptional and unexpected long stays were designated as outliers. Visualization of the length-of-stay frequency distributions revealed that the "tail" of the distributions began at a stay of about 10 days, and this was chosen as the threshold for long-term patients. A threshold of 30 days was chosen as the outlier threshold since only isolated patients stayed longer. The impact (long-term patients/total admissions) of long-term patients on bed utilization was assessed and year-to-year differences examined. Long-term patients staying at least 10 days used 2.7-5.0 bed-years. Long-term patients can have a major impact on ICU bed utilization. With 23-45% of the beds occupied by long-term patients, the availability of beds for short-stay patients is reduced. This is important in ICUs where efficient patient throughput is vital, so that beds are availability for both elective and emergency admissions.