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


METHODS
Comparison before and after the intervention.


METHODS
A surgical ICU at a university hospital.


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


METHODS
Closure of one bed out of 17.


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.
Wasserfallen
Jean-Blaise
JB
Medical direction, CHUV-BH 08, Rue du Bugnon, 1011 Lausanne, Switzerland. jwasserf@chuv.hospvd.ch
Revelly
Jean-Pierre
JP
Moro
Davide
D
Gilliard
Nicolas
N
Rouge
Jacques
J
Chioléro
René
R
D015276:Health Care Rationing; D006742:Hospital Bed Capacity; D006801:Humans; D007362:Intensive Care Units; D005791:Patient Care; D017064:Process Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D018709:Statistics, Nonparametric; D013557:Switzerland