132 Impact of hospital census and ICU throughput on hospital length of stay

Introduction: High acuity hospitals often experience delays in transferring patients from one care unit to another within the facility. One strategy to increase inpatient ward capacity and improve throughput is to delay transfer of appropriate patients from intensive care units (ICU’s) to inpatient wards. The practice of boarding “floor” patients in the ICU when there is a lack of inpatient floor beds assumes that patients will receive the appropriate care necessary to progress toward hospital discharge.Hypothesis: We hypothesized that the care provided in an inpatient ward and an ICU boarding a “floor” patient were not equivalent in terms of ancillary services and appropriate resources to prepare patients for eventual discharge from the hospital. This difference has the potential to impact length of stay and further degrade hospital throughput.Methods: We conducted a retrospective analysis of patients admitted to the Weinberg Intensive Care Unit (WICU) between July 1, 2011 and June 30, 2012. Patients were divided into two group based on whether patients remained in the ICU after critical care services were no longer deemed necessary. Suitability for ICU discharge was reached by consensus between the patients’ primary surgeon and an intensive care physician. Our control group consisted of patients that left the ICU within 24 hours of being deemed appropriate for transfer. The floor group consisted of patients that remained in the ICU for greater than 24 hours after meeting clinical discharge criteria. Our primary outcome measure was length of hospital stay.Results: During the study period there were 1518 patients qualified for our control group and 129 patients met criteria for our boarding group. Using a linear regression model we determined that there were no significant differences between the groups in terms of age, sex, APR severity, admitting service, and mortality. Patients in the floor group had a statistically significant increase in the mean length of stay when compared to the standard group (13.0 days vs. 10.6 days p \u3c 0.05).Conclusions: These results suggest that boarding patients in an ICU when critical care services are no longer needed is associated with increased hospital length of stay in otherwise similar patients. It is possible that this increase is due to bias in selection of patients, exposure to pathogens in the ICU environment, or delays in progression of care along normal pathways of recovery. Further study will need to prospectively address the finding that delayed discharge of patients from the ICU increases hospital LOS