Capacity Strain Increases Mortality Risk among Patients Admitted to Intensive Care Units – A Two-Stage Modeling Strategy
CCCF ePoster library. Bagshaw S. Oct 28, 2015; 117331; P104 Disclosure(s): Partnership for Research and Innovation in the Health System (PRIHS), Alberta Innovates – Health Solutions.
Dr. Sean M Bagshaw
Dr. Sean M Bagshaw
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Abstract
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P104


Topic: Retrospective or Prospective Cohort Study


Capacity Strain Increases Mortality Risk among Patients Admitted to Intensive Care Units – A Two-Stage Modeling Strategy



Sean M. Bagshaw, X. Wang, D. Zygun, D. Zuege, P. Dodek, A. Garland, D. Scales, L. Berthiaume, D. Yergens, P. Faris, G. Chen, H. Stelfox

Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada | Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada | Division of Critical Care Medicine, St. Paul’s Hospital, UBC, Vancouver, Canada | Medicine, University of Manitoba, Winnipeg, Canada | Critical Care Medicine, Sunnybrook Medical Center, Toronto, Canada | Critical Care Medicine, Cumming School of Medicine, Calgary, Canada | Community Health Sciences, Cumming School of Medicine, Calgary, Canada | Statistical Support Unit, Center for Advancement of Health, Alberta Health Services, Calgary, Canada | Statistical Support Unit, Center for Advancement of Health, Alberta Health Services, Calgary, Canada | Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

Introduction: The changing demographic profile of the Alberta population may influence the demand for health services, in particular service areas with finite resources such as intensive care units (ICUs). Strain on ICU capacity may adversely impact patient outcomes.

Objectives: To investigate whether and how transient increases in ICU capacity strain influence ICU mortality.

Methods: Retrospective cohort study of 12,218 patients admitted to 9 ICUs in Alberta, Canada from June 2012 to December 2014. A two-stage modeling strategy was adopted to investigate both direct and indirect associations between ICU capacity strain (available beds ≤ 1; occupancy ≥ 95%) at the time of ICU admission and ICU mortality. We used a mixed effect multi-variable linear regression model to measure the influence of capacity strain measures on illness severity at ICU admission (Acute Physiologic and Chronic Health Evaluation [APACHE II] score), and a mixed effect multi-variable logistic regression model to describe the impact of both illness severity and capacity strain measures on ICU mortality. Simulation experiments estimated the integrated effect of capacity strain measures and illness severity on risk of ICU mortality.

Results: A total of 1,799 (14.7%) patients died in ICU. The capacity strain measure (available beds ≤ 1) was significantly associated with admission APACHE II score (coefficient 0.55; p < 0.001) and each one unit increase in admission APACHE II score elevated ICU mortality risk by 10.2% (95% CI, 9.5-10.8; p < 0.0001). The integrated effect of capacity strain (available beds ≤ 1) and APACHE II score was associated with an incremental 20.2% (95% CI, 6.7-35.3; p = 0.0012) increased risk of ICU mortality. When capacity strain was measured as occupancy ≥ 95% findings were similar. The effect on ICU mortality showed a gradient response with bed availability and percent occupancy. strain measures and illness severity on risk of ICU mortality.

Conclusion: ICU capacity strain at the time of patient admission was associated with incremental ICU mortality, driven partly by increases in illness severity among admitted patients. Ignoring the impact of capacity strain on admission patient acuity could lead to underestimation of the overall effect of strain on ICU mortality.

References: None.
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