Consumption of ICU resources by long-stay patients does not change over time: 9-year observation in a teaching hospital in the netherlands

Abstract

Background The steady increase of expected lifetime and mean age of people in the western world can only be accompanied by an increase in medical care and inherent use of Intensive Care (ICU) resources. We explored whether the use of ICU resources by long-stay patients has increased over time. Methods Data from all patients admitted to a 10-bed medical-surgical ICU between 1999-2007 were analyzed. In the study period, organizational aspects remained stable in the unit. In the first 24 hours, type of admission and medical history were recorded and APACHE-II scores were calculated. After discharge, patients were divided into four groups with ICU length of stay (LOS) <2, 3-6, 7-13 and >13 days. Data are shown as median [interquartile range]. Results Over the years, the number of patients admitted per year was stable at median 578 [IQR 535-588] with stable age (69 [56-77]) and APACHE-II scores (14 [10-20]). The average proportion of patients per year per LOS group remained stable. Long-stay patients (>13 days; N=42 [38-47] per year) comprised predominantly medical admissions (63.7%) and consumed 52.0% of yearly ICU treatment days. Mortality in this group (30.2%) was higher than in the groups with shorter LOS (14.8% in LOS <2, 18.3% in LOS 3-6 and 25.9% in LOS 7-13; P<0.001). Conclusion Consumption of ICU resources by long-stay patients was considerable, but did not change over time in our setting. Long-stay patients comprised predominantly medical admissions and showed highest mortality. These findings are important in view of futility and costs. © 2010, Nederlandse Vereniging voor Intensive Care. All Rights Reserved.