Lucienne TQ Cardoso , Cintia MC Grion , Tiemi Matsuo , Elza HT Anami , Ivanil AM Kauss , Ludmila Seko and Ana M Bonametti. Critical Care 2011, 15:R28doi:10.1186/cc9975. Published: 18 January 2011
Introduction
When the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients.
Methods
A prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, APACHE II score, therapeutic intervention, and SOFA score. All patients were followed until hospital discharge.
Results
401 patients were evaluated. 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% – 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio: 1.015; 95% CI 1.006 – 1.023; P = 0.001).
Conclusions
There is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes.
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