A retrospective cohort study of short-stay admissions to the medical intensive care unit: Defining patient characteristics and critical care resource utilization
Pooja N Pandit1, Mark Mallozzi1, Rahed Mohammed2, Gregory McDonough2, Taylor Treacy3, Nathaniel Zahustecher3, Erika J Yoo1
1 Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
2 Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
3 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
Dr. Erika J Yoo
MD, FCCP, Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, TJU and NJH, Sidney Kimmel Medical College, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA 19107
Source of Support: None, Conflict of Interest: None
Background: Little is known about the mortality and utilization outcomes of short-stay intensive care unit (ICU) patients who require <24 h of critical care. We aimed to define characteristics and outcomes of short-stay ICU patients whose need for ICU level-of-care is ≤24 h compared to nonshort-stay patients.
Methods: Single-center retrospective cohort study of patients admitted to the medical ICU at an academic tertiary care center in 2019. Fisher's exact test or Chi-square for descriptive categorical variables, t-test for continuous variables, and Mann–Whitney two-sample test for length of stay (LOS) outcomes.
Results: Of 819 patients, 206 (25.2%) were short-stay compared to 613 (74.8%) nonshort-stay. The severity of illness as measured by the Mortality Probability Model-III was significantly lower among short-stay compared to nonshort-stay patients (P = 0.0001). Most short-stay patients were admitted for hemodynamic monitoring not requiring vasoactive medications (77, 37.4%). Thirty-six (17.5%) of the short-stay cohort met Society of Critical Care Medicine's guidelines for ICU admission. Nonfull-ICU LOS, or time spent waiting for transfer out to a non-ICU bed, was similar between the two groups. Hospital mortality was lower among short-stay patients compared to nonshort-stay patients (P = 0.01).
Conclusions: Despite their lower illness severity and fewer ICU-level care needs, short-stay patients spend an equally substantial amount of time occupying an ICU bed while waiting for a floor bed as nonshort-stay patients. Further investigation into the factors influencing ICU triage of these subacute patients and contributors to system inefficiencies prohibiting their timely transfer may improve ICU resource allocation, hospital throughput, and patient outcomes.