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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(6):467–474. doi:10.1001/archinternmed.2011.2315
Author Affiliations: Departments of Critical Care Medicine (Drs Stelfox and Doig), Medicine (Drs Stelfox, Hemmelgarn, and Manns), Pediatrics (Dr Nijssen-Jordan), and Community Health Sciences (Drs Stelfox, Hemmelgarn, Doig, and Manns) and Institute for Public Health (Drs Stelfox, Hemmelgarn, Doig, and Manns), University of Calgary, and Alberta Health Services (Drs Stelfox, Hemmelgarn, Doig, Nijssen-Jordan, and Manns and Mr Gao), Calgary, and Division of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton (Dr Bagshaw), Alberta, Canada.
Background Intensive care unit (ICU) beds, a scarce resource, may require prioritization of admissions when demand exceeds supply. We evaluated the effect of ICU bed availability on processes and outcomes of care for hospitalized patients with sudden clinical deterioration.
Methods We identified consecutive hospitalized adults in Calgary, Alberta, Canada, with sudden clinical deterioration triggering medical emergency team activation between January 1, 2007, and December 31, 2009. We compared ICU admission rates (within 2 hours of medical emergency team activation), patient goals of care (resuscitative, medical, and comfort), and hospital mortality according to the number of ICU beds available (0, 1, 2, or >2), adjusting for patient, physician, and hospital characteristics (using data from clinical and administrative databases).
Results The cohort consisted of 3494 patients. Reduced ICU bed availability was associated with a decreased likelihood of patient admission within 2 hours of medical emergency team activation (P = .03) and with an increased likelihood of change in patient goals of care (P < .01). Patients with sudden clinical deterioration when zero ICU beds were available were 33.0% (95% CI, −5.1% to 57.3%) less likely to be admitted to the ICU and 89.6% (95% CI, 24.9% to 188.0%) more likely to have their goals of care changed compared with when more than 2 ICU beds were available. Hospital mortality did not vary significantly by ICU bed availability (P = .82).
Conclusion Among hospitalized patients with sudden clinical deterioration, we noted a significant association between the number of ICU beds available and ICU admission and patient goals of care but not hospital mortality.
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