title: Organizational factors associated with decreased mortality among Veterans Affairs patients with an ICU stay.
abstract: In-hospital mortality rates associated with an ICU stay are high and vary widely among units. This variation may be related to organizational factors such as staffing patterns, ICU structure, and care processes. We aimed to identify organizational factors associated with variation in in-hospital mortality for patients with an ICU stay. This was a retrospective observational cross-sectional study using administrative data from 34 093 patients from 171 ICUs in 119 Veterans Health Administration hospitals. Staffing and patient data came from Veterans Health Administration national databases. ICU characteristics came from a survey in 2004 of ICUs within the Veterans Health Administration. We conducted multilevel multivariable estimation with patient-, unit-, and hospital-level data. The primary outcome was in-hospital mortality. Of 34 093 patients, 2141 (6.3%)died in the hospital. At the patient level, risk of complications and having a medical diagnosis were significantly associated with a higher risk of mortality. At the unit level, having an interface with the electronic medical record was significantly associated with a lower risk of mortality. The finding that electronic medical records integrated with ICU information systems are associated with lower in-hospital mortality adds support to existing evidence on organizational characteristics associated with in-hospital mortality among ICU patients.
authors: University of Alberta, Edmonton, Alberta, Canada.
authors: Anne E
authors: AE
authors: Sales
authors: Gwendolyn G
authors: GG
authors: Lapham
authors: Janet
authors: J
authors: Squires
authors: Alison
authors: A
authors: Hutchinson
authors: Peter
authors: P
authors: Almenoff
authors: Nancy D
authors: ND
authors: Sharp
authors: Elliott
authors: E
authors: Lowy
authors: Yu-Fang
authors: YF
authors: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D006751:Hospital Information Systems; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States; D014493:United States Department of Veterans Affairs