title: The impact of the organization of high-dependency care on acute hospital mortality and patient flow for critically ill patients.
abstract: BACKGROUND
  Little is known about the utility of provision of high-dependency care (HDC) that is in a geographically separate location from a primary intensive care unit (ICU).
  
  
  OBJECTIVE
  To determine whether the availability of HDC in a geographically separate unit affects patient flow or mortality for critically ill patients.
  
  
  METHODS
  Admissions to ICUs in the United Kingdom, from 2009 to 2011, who received Level 3 intensive care in the first 24 hours after admission and subsequently Level 2 HDC. We compared differences in patient flow and outcomes for patients treated in hospitals providing some HDC in a geographically separate unit (dual HDC) with patients treated in hospitals providing all HDC in the same unit as intensive care (integrated HDC) using multilevel mixed effects models.
  
  
  RESULTS
  In 192 adult general ICUs, 21.4% provided dual HDC. Acute hospital mortality was no different for patients cared for in ICUs with dual HDC versus those with integrated HDC (adjusted odds ratio, 0.94 [0.86-1.03]; P = 0.16). Dual HDC was associated with a decreased likelihood of a delayed discharge from the primary unit. However, total duration of critical care and the likelihood of discharge from the primary unit at night were increased with dual HDC.
  
  
  CONCLUSIONS
  Availability of HDC in a geographically separate unit does not impact acute hospital mortality. The potential benefit of decreasing delays in discharge should be weighed against the increased total duration of critical care and greater likelihood of a transfer out of the primary unit at night.
authors.affiliation: 1 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: David A
authors.initials: DA
authors.lastname: Harrison
authors.forename: Andrew
authors.initials: A
authors.lastname: Jones
authors.forename: Kathryn
authors.initials: K
authors.lastname: Rowan
mesh_terms: D018806:APACHE; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D007380:Intermediate Care Facilities / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology
keywords: intensive care unit; intermediate care facilities; length of stay; mortality