title: There's no place like home: boarding surgical ICU patients in other ICUs and the effect of distances from the home unit.
abstract: BACKGROUND
  Intensive care units (ICUs) function frequently at capacity, requiring incoming critically ill patients to be placed in alternate geographically distinct ICUs. In some medical ICU populations, "boarding" in an overflow ICU has been associated with increased mortality. We hypothesized that surgical ICU patients experience more complications when boarding in an overflow ICU and that the frequency of these complications are greatest in boarders farthest from the home unit (HU).
  
  
  METHODS
  A 5-year (June 2005 to June 2010) retrospective review of a prospectively maintained ICU database was performed, and demographics, severity of illness, length of stay, and incidence of ICU complications were extracted. Distances between boarding patients' rooms and the HU were measured. Complications occurring in patients located in the same floor (BUSF) and different floor (BUDF) boarding units were compared and stratified by distance from HU to the patient room. Logistic regression was used to develop control for known confounders.
  
  
  RESULTS
  A total of 7,793 patients were admitted to the HU and 833 to a boarding unit (BUSF, n = 712; BUDF, n = 121). Boarders were younger, had a lower length of stay, and Acute Physiology and Chronic Health Evaluation II and were more often trauma/emergency surgery patients. Compared with in-HU patients, the incidence of aspiration pneumonia (2.2% vs. 3.6%, p < 0.01) was greater in BUSF patients and highest in those farthest from the HU (odds ratio [OR], 2.39; p = 0.01). Delirium occurred less often in HU than in BUDF patients (3.3% vs. 8.3 %, p < 0.01), and both delirium (OR, 6.09, p < 0.01) and ventilator-associated pneumonia (OR, 4.49, p < 0.05) were more frequent in patients farther from the HU.
  
  
  CONCLUSIONS
  Certain ICU complications occur more frequently in boarding patients particularly if they are located on a different floor or far from the HU. When surgical ICU bed availability forces overflow admissions to non-home ICUs, greater interdisciplinary awareness, education, and training may be needed to ensure equivalent care and outcomes.
  
  
  METHODS
  Epidemiologic study, level III. Therapeutic study, level IV.
authors.affiliation: From the Division of Traumatology, Surgical Critical Care & Emergency Surgery (J.L.P., N.W.B., D.N.H., M.D., S.R.A., N.D.M., C.S., C.W.S., P.M.R.), and Department of Anesthesia and Critical Care (B.A.K.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and University of Virginia Medical Center (M.R.), Charlottesville, Virginia.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Pascual
authors.forename: Nicholas W
authors.initials: NW
authors.lastname: Blank
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Robertson
authors.forename: Mouhamed
authors.initials: M
authors.lastname: Diop
authors.forename: Steve R
authors.initials: SR
authors.lastname: Allen
authors.forename: Niels D
authors.initials: ND
authors.lastname: Martin
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kohl
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Sims
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult