Archive for the ‘Intensive Care’ Category

The current findings suggest that small, but clinically meaningful differences may exist across institutions. Directing care preferentially to such institutions may be associated with improved outcomes on a community-wide basis. Nevertheless, important questions regarding the feasibility of such practices need to be explicitly explored. For example, which core ICU services should be provided by all […]

Third, the lack of a unique patient identifier in the database precluded our ability to follow up patients beyond hospital discharge, and to examine hospital readmission and postdischarge mortality. Although such information would allow for a more thorough assessment of the effectiveness of ICU care, routine collection of identifiers, such as the social security number, […]

Fourth, the decline in overall standardized mortality over the 4 years of data collection and dissemination may suggest improvements in care over time.- However, further analyses indicated that rates of discharge to skilled nursing facilities also increased over time, and that these patients had markedly higher severity of illness than patients discharged home. Moreover, excluding […]

Nevertheless, overestimation may reflect general improvements in ICU care and patient outcomes since the development of APACHE III, differences in discharge practices of the current hospitals with triage of ill patients to skilled nursing facilities, differences in ICU utilization with higher numbers of discretionary admissions, or the provision of more effective care in the current […]

The current study represents one of the largest evaluations of variations in ICU mortality, and the first study (to our knowledge) to include all hospitals providing critical care services in a single metropolitan region. In analyses of > 116,000 patients admitted to ICUs in 28 hospitals over a 4-year period, several important findings emerge. First, […]

Coincident with the decline in SMRs, declines were observed in total hospital LOS (13.0, 12.4, 11.6, and 11.1 days in years 1, 2, 3, and 4, respectively; p < 0.001) and ICU LOS (4.0, 3.9, 3.8, and 3.8 days in years 1 to 4, respectively; p < 0.001), while the proportion of patients discharged to skilled nursing […]

The variation in observed mortality rates across hospitals was wide, ranging from 4.3 to 15.8%. Based on the locally derived model, mean predicted risks of death ranged from 3.6 to 15.8%. At a hospital level, the mean predicted risk of death explained 87% of the variance in observed hospital mortality rates (ie, R2 = 0.87). […]