There's no place like home: boarding surgical ICU patients in other ICUs and the effect of distances from the home unit. J Trauma Acute Care Surg 2014 Apr;76(4):1096-102
Date
03/26/2014Pubmed ID
24662877Pubmed Central ID
PMC4156017DOI
10.1097/TA.0000000000000180Scopus ID
2-s2.0-84897084676 (requires institutional sign-in at Scopus site) 23 CitationsAbstract
BACKGROUND: Intensive care units (ICUs) function frequently at capacity, requiring incoming critically ill patients to be placed in alternate geographically distinct ICUs. In some medical ICU populations, "boarding" in an overflow ICU has been associated with increased mortality. We hypothesized that surgical ICU patients experience more complications when boarding in an overflow ICU and that the frequency of these complications are greatest in boarders farthest from the home unit (HU).
METHODS: A 5-year (June 2005 to June 2010) retrospective review of a prospectively maintained ICU database was performed, and demographics, severity of illness, length of stay, and incidence of ICU complications were extracted. Distances between boarding patients' rooms and the HU were measured. Complications occurring in patients located in the same floor (BUSF) and different floor (BUDF) boarding units were compared and stratified by distance from HU to the patient room. Logistic regression was used to develop control for known confounders.
RESULTS: A total of 7,793 patients were admitted to the HU and 833 to a boarding unit (BUSF, n = 712; BUDF, n = 121). Boarders were younger, had a lower length of stay, and Acute Physiology and Chronic Health Evaluation II and were more often trauma/emergency surgery patients. Compared with in-HU patients, the incidence of aspiration pneumonia (2.2% vs. 3.6%, p < 0.01) was greater in BUSF patients and highest in those farthest from the HU (odds ratio [OR], 2.39; p = 0.01). Delirium occurred less often in HU than in BUDF patients (3.3% vs. 8.3 %, p < 0.01), and both delirium (OR, 6.09, p < 0.01) and ventilator-associated pneumonia (OR, 4.49, p < 0.05) were more frequent in patients farther from the HU.
CONCLUSION: Certain ICU complications occur more frequently in boarding patients particularly if they are located on a different floor or far from the HU. When surgical ICU bed availability forces overflow admissions to non-home ICUs, greater interdisciplinary awareness, education, and training may be needed to ensure equivalent care and outcomes.
LEVEL OF EVIDENCE: Epidemiologic study, level III. Therapeutic study, level IV.
Author List
Pascual JL, Blank NW, Holena DN, Robertson MP, Diop M, Allen SR, Martin ND, Kohl BA, Sims CA, Schwab CW, Reilly PMAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Child
Critical Illness
Female
Follow-Up Studies
Hospital Mortality
Hospitalization
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Odds Ratio
Retrospective Studies
Time Factors
Young Adult
