ArticleAnnals of internal medicine2013
Outcomes among patients discharged from busy intensive care units.
Article in Annals of internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 72 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
72 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Patients and staff perspectives on hospital ward strain and its impacts on patient care and the workforce: a mixed-methods systematic review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Pooled it
- Indicators of intensive care unit capacity strain: a systematic review.Critical care (London, England) · 2018Pooled it
- The Association Between Hospital Capacity Strain and Inpatient Outcomes in Highly Developed Countries: A Systematic Review.Journal of general internal medicine · 2017Pooled it
- Prevalence and Characteristics of Potentially Avoidable Interhospital Transfers.JAMA network open · 2026Article
- Contributors to perceived workload strain in the pediatric intensive care unit.Intensive care medicine. Paediatric and neonatal · 2026Article
- Intensive care patients eligible for intermediate care unit-level care: a single-centre prospective cohort study in Belgium.Critical care science · 2026Article
- Strain in the Pediatric Intensive Care Unit and its Association with Patient Outcomes.Journal of intensive care medicine · 2025Article
- Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital.Acute and critical care · 2025Article
- Development of a Simple Scoring System for Predicting Discharge Safety from the Medical ICU to Low-Acuity Wards: The Role of the Sequential Organ Failure Assessment Score, Albumin, and Red Blood Cell Distribution Width.Journal of personalized medicine · 2024Article
- A Data-Driven Analysis of Ward Capacity Strain Metrics That Predict Clinical Outcomes Among Survivors of Acute Respiratory Failure.Journal of medical systems · 2023Article
- Characterizing Equity of Intensive Care Unit Admissions for Sepsis and Acute Respiratory Failure.Annals of the American Thoracic Society · 2022Article
- Exploratory analysis of novel electronic health record variables for quantification of healthcare delivery strain, prediction of mortality, and prediction of imminent discharge.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Association of ICU Admission and Outcomes in Sepsis and Acute Respiratory Failure.American journal of respiratory and critical care medicine · 2022Article
- Investigating the cognitive capacity constraints of an ICU care team using a systems engineering approach.BMC anesthesiology · 2022Article
- Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study.Wellcome open research · 2022Article
- Predictors of Delayed Recognition of Critical Illness in Emergency Department Patients and Its Effect on Morbidity and Mortality.Journal of intensive care medicine · 2022Article
- Clinical and Laboratory Profile of COVID-19 Pneumonia Patients With a Complicated Post-Intensive Care Unit Hospital Course.Journal of clinical medicine research · 2021Article
- The association between mechanical ventilator compatible bed occupancy and mortality risk in intensive care patients with COVID-19: a national retrospective cohort study.BMC medicine · 2021Observational
- Variation of Daily Care Demand in Swiss General Hospitals: Longitudinal Study on Capacity Utilization, Patient Turnover and Clinical Complexity Levels.Journal of medical Internet research · 2021Article
- Analysis of Hospital Resource Availability and COVID-19 Mortality Across the United States.Journal of hospital medicine · 2021Article
12 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundStrains on the capacities of intensive care units (ICUs) may influence the quality of ICU-to-floor transitions.
objectiveTo determine how 3 metrics of ICU capacity strain (ICU census, new admissions, and average acuity) measured on days of patient discharges influence ICU length of stay (LOS) and post-ICU discharge outcomes.
designRetrospective cohort study from 2001 to 2008.
setting155 ICUs in the United States. PATIENTS: 200 730 adults discharged from ICUs to hospital floors. MEASUREMENTS: Associations between ICU capacity strain metrics and discharged patient ICU LOS, 72-hour ICU readmissions, subsequent in-hospital death, post-ICU discharge LOS, and hospital discharge destination.
resultsIncreases in the 3 strain variables on the days of ICU discharge were associated with shorter preceding ICU LOS (all P < 0.001) and increased odds of ICU readmissions (all P < 0.050). Going from the 5th to 95th percentiles of strain was associated with a 6.3-hour reduction in ICU LOS (95% CI, 5.3 to 7.3 hours) and a 1.0% increase in the odds of ICU readmission (CI, 0.6% to 1.5%). No strain variable was associated with increased odds of subsequent death, reduced odds of being discharged home from the hospital, or longer total hospital LOS. LIMITATION: Long-term outcomes could not be measured.
conclusionWhen ICUs are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly and, perhaps consequentially, have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected. These results suggest that bed availability pressures may encourage physicians to discharge patients from the ICU more efficiently and that ICU readmissions are unlikely to be causally related to patient outcomes. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality; National Heart, Lung, and Blood Institute; and Society of Critical Care Medicine.
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