Five-Year Trends of Critical Care Practice and Outcomes

doi:10.1016/j.chest.2017.06.050

Chest

Volume 152, Issue 4, October 2017, Pages 723-735

https://doi.org/10.1016/j.chest.2017.06.050 Get rights and content

Background

Longitudinal analyses of large, detailed adult critical care datasets provide insights into practice trends and generate useful outcome and process benchmarks.

Methods

Data representing 991,571 consecutive critical care visits to 160 US adult ICUs from 2009 to 2013 from the eICU Research Institute clinical practice database were used to quantitate patient characteristics, APACHE IV–based acuity predictions, treatments, and outcomes. Analyses for changes over time were performed for patient characteristics, entry and discharge locations, primary admission diagnosis, treatments, adherence to consensus ICU best practices, length of stay (LOS), and inpatient mortality.

Results

We detected significant trends for increasing age, BMI, and risk of mortality, higher frequency of admission from an ED and stepdown unit, and more frequent hospital discharge to substance abuse centers and skilled nursing facilities. Significantly more patients were admitted for sepsis, emphysema, coma, congestive heart failure, diabetic ketoacidosis, and fewer were admitted for asthma, unspecified chest pain, coronary artery bypass graft, and stroke care. The frequency of noninvasive mechanical ventilation and adherence to critical care best practices significantly increased, whereas the duration of renal replacement therapies, frequency of transfusions, antimicrobial use, critical care complications, LOS, and inpatient mortality decreased.

Conclusions

Analyses of patients, practices, and outcomes from a large geographically dispersed sample of adult ICUs revealed trends of increasing age and acuity, higher rates of adherence to best practice, use of noninvasive mechanical ventilation, and decreased use of antimicrobials, transfusions, and duration of renal replacement therapies. Acuity-adjusted LOS and in hospital mortality decreased.

Section snippets

Methods

The data for this study are derived from patients of the Philips eICU Research Institute (eRI) data repository with hospital discharge dates during the calendar years 2009 to 2013 for ICUs contributing data for each of these years. ICU characteristics were derived from a validated survey.¹³ The methods of data acquisition, validation, aggregation, and security procedures14, 15 and a detailed description of the ICUs has been published in CHEST.¹³ Study enrollment and exclusions are presented in

Trends for the Demographic Characteristics of Adult Critical Illness

This study includes records from 991,571 ICU visits to one of 3,080 adult ICU beds of 160 ICUs, located in 103 United States nonfederal hospitals of 29 health care systems from 24 states. A detailed description of the ICUs, hospitals, and health delivery networks of this population has been published.¹³ This publication reported that 61% of eRI ICUs are located in hospitals with less than 300 licensed beds, 31% are in hospitals with 301 to 750 beds, and 8% are in hospitals with more than 750

Discussion

The main findings of this five-year study are that the primary admission diagnoses of adults who use critical care services, the locations from which they enter an ICU, the treatments that they receive, and their outcomes have significantly changed. Among the many changes observed by this study, perhaps the most important to critical care practitioners are the trends to lower hospital mortality and shorter LOS. These outcomes occur in concert with trends for changes of practice and patient

Acknowledgments

Author contributions: C. M. L. had full access to the data and takes responsibility for its integrity and the accuracy of the analyses. Study concept and design: C. M. L., O. B., R. R. R. Acquisition and preparation of data: S. S., C. J. L., O. B. Analysis and interpretation of the data: C. M. L., S. S., X. L., O. B.

Financial/nonfinancial disclosures: The authors have report to CHEST the following: X. L. and S. S. are employees of Philips Healthcare. O. B. is an employee of Philips Healthcare

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: FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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Chest

Original Research: Critical CareFive-Year Trends of Critical Care Practice and Outcomes

Background

Methods

Results

Conclusions

Section snippets

Methods

Trends for the Demographic Characteristics of Adult Critical Illness

Discussion

Acknowledgments

J Crit Care

Chest

Chest

Chest

Med Intensiva

J Crit Care

Am J Cardiol

Resuscitation

Adv Surg

J Diabetes Complications

Lancet

Emerg Med Clin North Am

Articles published and downloaded by public health scientists: analysis of data from the CDC Public Health Library, 2011-2013

J Public Health Manag Pract

Publication of Secondary analyses from randomized trials in critical care

N Engl J Med

Medicare intensive care unit use: analysis of incidence, cost, and payment

Crit Care Med

Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population?

JAMA

Critical care use during the course of serious illness

Am J Respir Crit Care Med

Original Research: Critical Care
Five-Year Trends of Critical Care Practice and Outcomes