Does the number of vacant beds in general wards affect the time to ICU admission of medical patients from the emergency department?: A prospective observational study

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2020. Background: The time to intensive care unit (ICU) admission of new critically-ill patients presenting at the emergency department (ED) is affected by the ICU scarcity. The number of vacant beds in general wards could affect the ICU admission via the mechanism of outflow limitation. Objective: The present study aimed to find whether the bed vacancy in general wards affected the time to ICU admission of new medical patients from the ED. This could suggest whether an expansion of the beds in general wards would hasten ICU admission processes. Materials and Methods: The present study was a prospective, observational study. The medical patients presenting at the ED with indication for ICU admission were consecutively enrolled. The primary outcome was the correlation between the time to ICU and the number of available bed in general wards at admission time. When the ICU bed was immediately available, the correlation between the time to ICU and the number of vacant ICU beds was also analyzed. The clinical outcomes and other potential factors associated with the time to ICU were collected. Results: Two hundred fifty-two patients were included. The time to ICU did not correlate with the bed vacancy in general wards but well correlated with the number of immediately available ICU bed. It was also independently associated with the patients’ Sequential Organ Failure Assessment (SOFA) score, arterial pH, and the need to wait for ICU vacancy. Longer time to ICU and higher SOFA score were independently associated with higher hospital mortality. Conclusion: The number of available beds in general wards did not correlate with the time to ICU admission of new patients. The ICU admission time seems to link with the bed management strategies and case triaging. With limited ICU beds, triaging patients by severity and sparing an ICU bed at all times could possibly improve the patients’ outcomes.