Key result
Extreme ICU capacity strain shows no association with increased mortality, infections, or readmissions.
Why the study?
The impact of prolonged ICU occupancy strain and the use of non-intensive care beds for critical care delivery in hospitals was not well characterized.
Observational
No
Sustained extreme ICU strain was not linked to worse measured outcomes; leaves open generalizability and effects on unmeasured harms.
Since 2000, there has been a marked reduction in non-clinical critical care transfers in England. ICNARC have reported that this has been associated with a reduction in case-mix adjusted mortality (1). One consequence has been the need to open critical care beds in non-specified locations in hospitals such as post anaesthesia recovery and high dependency areas. Here we report the consequences of an unprecedented strain on ICU capacity sustained at a central London teaching hospital over a 12 month period in 2013 (graph 1). During this period, ICU capacity reached >150% requiring a number of different emergent solutions including the use of main theatre recovery and high dependency areas. We also describe some of the clinical and operational lessons we learnt.
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Hopkins et al. (2015) conducted an observational in Critical illness requiring intensive care. Prolonged ICU occupancy strain (>150%) vs. Contemporaneous casemix program data was evaluated on Standardised mortality ratio (SMR), readmission, and ICU-acquired infection rates. A sustained 12-month period of extreme ICU capacity strain (>150%) was not associated with any change in case-mix adjusted standardised mortality ratio, hospital-acquired infection, or re-admission rates.
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