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J Korean Soc Emerg Med > Volume 32(2); 2021 > Article
Journal of The Korean Society of Emergency Medicine 2021;32(2): 170-178.
중환자실 병상 감소가 중환자의 응급센터 체류시간과 임상 결과에 미치는 영향
임대황 , 성원영 , 이장영 , 이원석 , 서상원 , 이근택
을지대학교 의과대학 응급의학교실
Impact of decreased intensive care unit bed capacity on the emergency department length of stay and clinical outcomes of critically ill patients
Dae Whang Lim , Won Young Sung , Jang Young Lee , Won Suk Lee , Sang Won Seo , Keun Taek Lee
Department of Emergency Medicine, Eulji University College of Medicine, Daejeon, Korea
Correspondence  Won Young Sung ,Tel: 042-611-3256, Fax: 042-611-3880, Email: sage77@eulji.ac.kr,
Received: June 2, 2020; Revised: July 19, 2020   Accepted: August 10, 2020.  Published online: April 30, 2021.
ABSTRACT
Objective:
This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients.
Method:
This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality.
Results:
A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001).
Conclusion:
In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.
Key words: Intensive care unit; Emergency department; Length of stay; Mortality
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