The longer patients are in hospital before Intensive Care admission the higher their mortality

Abstract

Objective To explore the relationship between hospital mortality and time spent by patients on hospital wards before admission to the intensive care unit (ICU). Design Observational study of prospectively collected data. Setting Participating intensive care units within the North East Thames Regional Database. Patients and participants Patients, 7,190, admitted to ICU from the hospital wards of 24 hospitals. Interventions None. Measurements and results Of ICU admissions from the wards, 40.1% were in hospital for more than 3 days and 11.7% for more than 15 days. ICU patients who died in hospital were in-patients longer (p=0.001) before admission (median 3 days; interquartile range 1–9) than those discharged alive (median 2 days; interquartile range 1–5). Hospital mortality increased significantly (pp<0.001) in patient age, APACHE II score and predicted mortality in relation to time on wards before ICU admission. Conclusions Mortality was high among patients admitted from the wards to ICU; many were inpatients for days or weeks before admission. The longer these patients were in hospital before ICU admission, the higher their mortality. Patients with delayed admission differed in some respects compared to those admitted earlier.