The characteristics of very short stay ICU admissions and implications for optimizing ICU resource utilization: the Saudi experience.
OBJECTIVE
Patients with very short stays (<24 hours) in intensive care units (ICUs) constitute a distinct group with a high turnover rate and a unique patient mix. Our aim was to study their characteristics with the aim of developing strategic approaches for better and more appropriate utilization of ICU resources.


METHODS
Prospective cohort study.


METHODS
Adult medical/surgical ICU in a tertiary care teaching hospital.


METHODS
All admissions in an adult ICU from March 1999 to February 2001 and staying <24 hours were enrolled. Relevant data were collected on these patients, their course and outcome, and analyzed after categorizing patients according to: (i) the nature of admission; and (ii) risk of death (ROD) estimated by Mortality Probability Model II(0).


RESULTS
Patients staying <24 hours (n = 304) formed 27.8% of all ICU admissions, with an ICU mortality rate of 26.3%. Only 45.4% of them utilized ICU-specific procedures. Around one-third (32.6%) were elective admissions comprising younger patients, with a significantly lower prevalence of chronic illness, a lower ROD, and utilization of less ICU-specific procedures, with very few mortalities. When stratified using RODs into low-, intermediate-, and high-risk groups, significant differences were found with respect to age, nature of ICU admission, presence of chronic illness, utilization of ICU-specific procedures, having do-not-resuscitate (DNR) orders, length of ICU stay, and ICU and hospital outcomes.


CONCLUSIONS
Our study has provided crucial input for the study of strategic change towards more optimal utilization of scarce ICU resources. Implementing protocols to target ICU care to patients most likely to benefit, making DNR decisions early in the hospital stay, and operating an Intermediate Care Unit have been proposed as strategic approaches.
Arabi
Yaseen
Y
Department of Intensive Care, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. arabi@ngha.med.sa
Venkatesh
S
S
Haddad
Samir
S
Al Malik
Salim
S
Al Shimemeri
Abdullah
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D017598:Efficiency, Organizational; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D016414:Resuscitation Orders; D018570:Risk Assessment; D012529:Saudi Arabia