Can the impact of bed closure in intensive care units be reliably monitored?

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Serval ID
serval:BIB_E6879440730D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Can the impact of bed closure in intensive care units be reliably monitored?
Journal
Intensive care medicine
Author(s)
Wasserfallen J.B., Revelly J.P., Moro D., Gilliard N., Rouge J., Chioléro R.
ISSN
0342-4642
Publication state
Published
Issued date
2004
Peer-reviewed
Oui
Volume
30
Number
6
Pages
1134-9
Language
english
Notes
Publication types: Journal Article - Publication Status: ppublish
Abstract
OBJECTIVE: To assess the properties of various indicators aimed at monitoring the impact on the activity and patient outcome of a bed closure in a surgical intensive care unit (ICU). DESIGN: Comparison before and after the intervention. SETTING: A surgical ICU at a university hospital. PATIENTS: All patients admitted to the unit over two periods of 10 months. INTERVENTION: Closure of one bed out of 17. MEASUREMENTS AND RESULTS: Activity and outcome indicators in the ICU and the structures upstream from it (emergency department, operative theater, recovery room) and downstream from it (intermediate care units). After the bed closure, the monthly medians of admitted patients and ICU hospital days increased from 107 (interquartile range 94-112) to 113 (106-121, P=0.07) and from 360 (325-443) to 395 (345-436, P=0.48), respectively, along with the linear trend observed in our institution. All indicators of workload, patient severity, and outcome remained stable except for SAPS II score, emergency admissions, and ICU readmissions, which increased not only transiently but also on a mid-term basis (10 months), indicating that the process of patient care delivery was no longer predictable. CONCLUSIONS: Health care systems, including ICUs, are extraordinary flexible, and can adapt to multiple external constraints without altering commonly used activity and outcome indicators. It is therefore necessary to set up multiple indicators to be able to reliably monitor the impact of external interventions and intervene rapidly when the system is no longer under control.
Keywords
Health Care Rationing, Hospital Bed Capacity, Humans, Intensive Care Units, Patient Care, Process Assessment (Health Care), Quality Indicators, Health Care, Statistics, Nonparametric, Switzerland
Pubmed
Web of science
Open Access
Yes
Create date
14/03/2008 10:20
Last modification date
01/10/2019 6:20
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