Assessing the association between occupancy and outcome in critically Ill hospitalized patients with sepsis.
BACKGROUND
Sepsis has a high prevalence, mortality-rate and cost. Sepsis patients usually enter the hospital through the Emergency Department (ED). Process or structural issues related to care may affect outcome.


METHODS
Multi-centered retrospective observational cohort study using administrative databases to identify adult patients (> = 18 years) with sepsis and severe sepsis admitted to Alberta Health Services Calgary zone adult multisystem intensive care units (ICU) through the ED between January 1, 2006 and September 30, 2009. We examined the association between ICU occupancy and hospital outcome. We explored other associations of hospital outcome including the effect of ED wait time, admission from ED during weekdays versus weekends and ED admission during the day versus at night.


RESULTS
One thousand and seven hundred seventy patients were admitted to hospital via ED, 1036 (58.5 %) with sepsis and 734 (41.5 %) with severe sepsis. In patients with sepsis, ICU occupancy > 90 % was associated with an increase in hospital mortality even after adjusting for age, sex, triage level, Charlson index, time of first ED physician assessment and ICU admission. No differences in hospital mortality were found for patients who waited more than 7 h, were admitted during the day versus night or weekdays versus weekends.


CONCLUSIONS
In patients with sepsis admitted via the ED, increased ICU occupancy was associated with higher in-hospital mortality.
Department of Community Health Sciences, University of Calgary, Calgary, Canada. dyergens@ucalgary.ca.
Dean W
DW
Yergens
Department of Community Health Sciences, University of Calgary, Calgary, Canada. wghali@ucalgary.ca.|Department of Internal Medicine, University of Calgary, Calgary, Canada. wghali@ucalgary.ca.|Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, Canada. wghali@ucalgary.ca.
William A
WA
Ghali
Department of Community Health Sciences, University of Calgary, Calgary, Canada. Peter.Faris@albertahealthservices.ca.|Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, Canada. Peter.Faris@albertahealthservices.ca.
Peter D
PD
Faris
Department of Community Health Sciences, University of Calgary, Calgary, Canada. hquan@ucalgary.ca.|Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, Canada. hquan@ucalgary.ca.
Hude
H
Quan
Department of Community Health Sciences, University of Calgary, Calgary, Canada. rjjolley@ucalgary.ca.
Rachel J
RJ
Jolley
Department of Community Health Sciences, University of Calgary, Calgary, Canada. cdoig@ucalgary.ca.|Department of Critical Care Medicine, University of Calgary, Calgary, Canada. cdoig@ucalgary.ca.|Department of Internal Medicine, University of Calgary, Calgary, Canada. cdoig@ucalgary.ca.|Snyder Institute for Chronic Disease, Faculty of Medicine, University of Calgary, Calgary, Canada. cdoig@ucalgary.ca.|Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, Canada. cdoig@ucalgary.ca.
Christopher J
CJ
Doig
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016638:Critical Illness; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality*; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D014218:Triage; D014850:Waiting Lists