Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain.

ABSTRACT:

Purpose

To estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients.

Methods

We performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a 'watchful waiting' cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care. Strain was classified as low, medium or high (2+, 1 or 0 empty beds). This instrumental variable (IV) analysis was repeated for the subgroup of referrals with a recommendation for critical care once assessed. Risk-adjusted 90-day survival models were also constructed.

Results

A total of 12,380 patients from 48 hospitals were available

SUBMITTER: Harris S 

PROVIDER: S-EPMC6006241 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature