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Erschienen in: Intensive Care Medicine 6/2004

01.06.2004 | Original

Can the impact of bed closure in intensive care units be reliably monitored?

verfasst von: Jean-Blaise Wasserfallen, Jean-Pierre Revelly, Davide Moro, Nicolas Gilliard, Jacques Rouge, René Chioléro

Erschienen in: Intensive Care Medicine | Ausgabe 6/2004

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Abstract

Objective

To assess the properties of various indicators aimed at monitoring the impact on the activity and patient outcome of a bed closure in a surgical intensive care unit (ICU).

Design

Comparison before and after the intervention.

Setting

A surgical ICU at a university hospital.

Patients

All patients admitted to the unit over two periods of 10 months.

Intervention

Closure of one bed out of 17.

Measurements and results

Activity and outcome indicators in the ICU and the structures upstream from it (emergency department, operative theater, recovery room) and downstream from it (intermediate care units). After the bed closure, the monthly medians of admitted patients and ICU hospital days increased from 107 (interquartile range 94–112) to 113 (106–121, P=0.07) and from 360 (325–443) to 395 (345–436, P=0.48), respectively, along with the linear trend observed in our institution. All indicators of workload, patient severity, and outcome remained stable except for SAPS II score, emergency admissions, and ICU readmissions, which increased not only transiently but also on a mid-term basis (10 months), indicating that the process of patient care delivery was no longer predictable.

Conclusions

Health care systems, including ICUs, are extraordinary flexible, and can adapt to multiple external constraints without altering commonly used activity and outcome indicators. It is therefore necessary to set up multiple indicators to be able to reliably monitor the impact of external interventions and intervene rapidly when the system is no longer under control.
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Metadaten
Titel
Can the impact of bed closure in intensive care units be reliably monitored?
verfasst von
Jean-Blaise Wasserfallen
Jean-Pierre Revelly
Davide Moro
Nicolas Gilliard
Jacques Rouge
René Chioléro
Publikationsdatum
01.06.2004
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 6/2004
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2205-9

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