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Relationship Between ICU Bed Availability, ICU Readmission, and Cardiac Arrest in the General Wards

Town, James A. MD; Churpek, Matthew M. MD, MPH; Yuen, Trevor C. BA; Huber, Michael T. MD; Kress, John P. MD; Edelson, Dana P. MD, MS

doi: 10.1097/CCM.0000000000000401
Clinical Investigations

Objective: The decision to admit a patient to the ICU is complex, reflecting patient factors and available resources. Previous work has shown that ICU census does not impact mortality of patients admitted to the ICU. However, the effect of ICU bed availability on patients outside the ICU is unknown. We sought to determine the association between ICU bed availability, ICU readmissions, and ward cardiac arrests.

Design: In this observational study using data collected between 2009 and 2011, rates of ICU readmission and ward cardiac arrest were determined per 12-hour shift. The relationship between these rates and the number of available ICU beds at the start of each shift (accounting for census and nursing capacity) was investigated. Grouped logistic regression was used to adjust for potential confounders.

Setting: Five specialized adult ICUs comprising 63 adult ICU beds in an academic medical center.

Patients: Any patient admitted to a non-ICU inpatient unit was counted in the ward census and considered at risk for ward cardiac arrest. Patients discharged from an ICU were considered at risk for ICU readmission.

Interventions: None.

Measurements and Main Results: Data were available for 2,086 of 2,190 shifts. The odds of ICU readmission increased with each decrease in the overall number of available ICU beds (odds ratio = 1.06; 95% CI, 1.00–1.12; p = 0.03), with a similar but not statistically significant association demonstrated in ward cardiac arrest rate (odds ratio = 1.06; 95% CI, 0.98–1.14; p = 0.16). In subgroup analysis, the odds of ward cardiac arrest increased with each decrease in the number of medical ICU beds available (odds ratio = 1.26; 95% CI, 1.06–1.49; p = 0.01).

Conclusions: Reduced ICU bed availability is associated with increased rates of ICU readmission and ward cardiac arrest. This suggests that systemic factors are associated with patient outcomes, and flexible critical care resources may be needed when demand is high.

1Department of Medicine, University of Chicago, Chicago, IL.

2Department of Health Studies, University of Chicago, Chicago, IL.

Dr. Edelson obtained the data and supervised the study. Dr. Huber, Dr. Town, and Mr. Yuen obtained and transcribed the raw data. Statistical analysis was performed by Dr. Churpek and Mr. Yuen. All authors contributed to the study design and article preparation.

Presented as an oral presentation at the Society of Hospital Medicine conference, Orlando, FL, April 3, 2012, and American Thoracic Society conference, San Francisco, CA, May 22, 2012.

Dr. Town is employed by Internal Medicine Residency. Dr. Edelson is supported by a career development award from the National Heart, Lung, and Blood Institute (NHLBI) (K23 HL097157-01). Dr. Edelson received support for article research from the National Institutes of Health, disclosed ownership interest in Quant HC (Chicago, IL), and has a patent pending (ARCD. P0535US.P2). Her institution received grant support from the NHLBI; Philips Healthcare; and Laerdal Medical and she consulted for EarlySense. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Dana P. Edelson, MD, MS, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 5000, Chicago, IL 60637. E-mail: dperes@uchicago.edu

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