Association Between In-hospital Mortality and the Institutional Factors of Intensive Care Units with a Focus on the Intensivist-to-bed Ratio: A Retrospective Cohort Study.

Autor:	Endo H; Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.; Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan., Okamoto H; Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan., Hashimoto S; Non Profit Organization, ICU Collaboration Network, Tokyo, Japan., Miyata H; Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.; Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	Journal of intensive care medicine [J Intensive Care Med] 2024 Oct; Vol. 39 (10), pp. 958-964. Date of Electronic Publication: 2024 Apr 03.
DOI:	10.1177/08850666241245645
Abstrakt:	Purpose: To elucidate the relationship between in-hospital mortality and the institutional factors of intensive care units (ICUs), with a focus on the intensivist-to-bed ratio. Methods: A retrospective cohort study was conducted using a Japanese ICU database, including adult patients admitted between April 1, 2020 and March 31, 2021. We used a multilevel logistic regression model to investigate the associations between in-hospital mortality and the following institutional factors: the intensivist-to-bed ratios on weekdays or over weekends/holidays, different work shifts, hospital-to-ICU-bed ratio, annual-ICU-admission-to-bed ratio, type of hospital, and the presence of other medical staff. Results: The study population comprised 46 503 patients admitted to 65 ICUs. The in-hospital mortality rate was 8.1%. The median numbers of ICU beds and intensivists were 12 (interquartile range [IQR] 8-14) and 4 (IQR 2-9), respectively. In-hospital mortality decreased significantly as the intensivist-to-bed ratio at 10 am on weekdays increased: the average contrast indicated a 20% (95% confidence interval [CI]: 1%-38%) reduction when the ratio increased from 0 to 0.5, and a 38% (95% CI: 9%-67%) reduction when the ratio increased from 0 to 1. The other institutional factors did not present a significant effect. Conclusions: The intensivist-to-bed ratio at 10 am on weekdays had a significant effect on in-hospital mortality. Further investigation is needed to understand the processes leading to improved outcomes. Competing Interests: Declaration of Conflicting InterestsHE and HM are affiliated with the Department of Healthcare Quality Assessment at the University of Tokyo, a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., Nipro Corporation, and Intuitive Surgical Sàrl. The other authors do not have any competing interests.
Databáze:	MEDLINE
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