Association of a Novel Index of Hospital Capacity Strain with Admission to Intensive Care Units.

Annals of the American Thoracic Society
George L AnesiVincent X Liu

Abstract

Rationale: Prior approaches to measuring healthcare capacity strain have been constrained by using individual care units, limited metrics of strain, or general, rather than disease-specific, populations.Objectives: We sought to develop a novel composite strain index and measure its association with intensive care unit (ICU) admission decisions and hospital outcomes.Methods: Using more than 9.2 million acute care encounters from 27 Kaiser Permanente Northern California and Penn Medicine hospitals from 2013 to 2018, we deployed multivariable ridge logistic regression to develop a composite strain index based on hourly measurements of 22 capacity-strain metrics across emergency departments, wards, step-down units, and ICUs. We measured the association of this strain index with ICU admission and clinical outcomes using multivariable logistic and quantile regression.Results: Among high-acuity patients with sepsis (n = 90,150) and acute respiratory failure (ARF; n = 45,339) not requiring mechanical ventilation or vasopressors, strain at the time of emergency department disposition decision was inversely associated with the probability of ICU admission (sepsis: adjusted probability ranging from 29.0% [95% confidence interval, 28.0-30....Continue Reading

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Citations

Dec 2, 2020·Annals of the American Thoracic Society·Patrick G Lyons, Shannon M Fernando
Mar 19, 2021·American Journal of Respiratory and Critical Care Medicine·Robinder G KhemaniRémi Coudroy

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