To determine variations among hospitals in use of intensive care units (ICUs) for patients with low severity of illness.
Retrospective cohort study.
Twenty-eight hospitals with 44 ICUs in a large metropolitan region.
Consecutive eligible patients (N=104 487) admitted to medical, surgical, neurological, or mixed medical-surgical ICUs from March 1,1991, to March 31,1995.
The predicted risk of inhospital death for each patient was assessed using a validated method that is based on age, ICU admission source, diagnosis, severe comorbid conditions, and abnormalities in 17 physiologic variables.
Admissions were classified as low severity if the patient's predicted risk of death was less than 1%. In a subset of 12 929 consecutive patients, use of 19 specific interventions typically delivered in ICUs was examined.
Twenty thousand four hundred fifty-one admissions (19.6%) were categorized as low severity, including 23.6% of postoperative and 16.9% of nonoperative admissions.
Alcohol and other drug overdoses accounted for 40.2% of nonoperative low-severity admissions ; laminectomy and carotid endarterectomy accounted for 52.3% of postoperative low-severity admissions.
Mortality among patients with low-severity illness was 0.3%, and only 28.6% received an ICU-specific intervention during the first ICU day.
Although mean ICU length of stay was shorter (P<. 001) in low-severity admissions. (...)
Mots-clés Pascal : Service hospitalier, Unité soin intensif, Admission hôpital, Malade, Utilisation, Coût, Homme, Risque faible
Mots-clés Pascal anglais : Hospital ward, Intensive care unit, Hospital admission, Patient, Use, Costs, Human, Low risk
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0277864
Code Inist : 002B30A04D. Création : 27/11/1998.