Effect upon mortality of the extension to holidays and weekends of the "ICU without walls" project. A before-after study

Abstract

Objective: To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital ("ICU without walls" project) results in decreased mortality among patients admitted to the ICU during those days.

Design: A quasi-experimental before-after study was carried out.

Setting: A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds.

Patients or participants: The control group involved no "ICU without walls" activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013. The intervention group in turn extended the "ICU without walls" activity to holidays and weekends, and included those patients admitted on those days between 1 May 2013 and 31 October 2014. Patients arriving from the operating room after scheduled surgery were excluded.

Variables of interest: An analysis was made of the demographic variables (age, gender), origin (emergency room, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities and SAPS 3 score as a measure of severity upon admission, stay in the ICU and in hospital, and mortality in the ICU and in hospital.

Results: A total of 389 and 161 patients were included in the control group and intervention group, respectively. There were no differences between the 2 groups except as regards cardiovascular comorbidity (49% in the control group versus 33% in the intervention group; P<.001), severity upon admission (median SAPS 3 score 52 [percentiles 25-75: 42-63) in the control group versus 48 [percentiles 25-75: 40-56] in the intervention group; P=.008) and mortality in the ICU (11% in the control group [95% CI 8-14] versus 3% [95% CI 1-7] in the intervention group; P=.003). In the multivariate analysis, the only 2 factors associated to mortality in the ICU were the SAPS 3 score (OR 1.08; 95% CI 1.06-1.11) and inclusion in the intervention group (OR 0.33; 95% CI 0.12-0.89).

Conclusions: Extension of the "ICU without walls" activity to holidays and weekends results in a decrease in mortality in the ICU.

Keywords: Critical care; Cuidados críticos; Decision support techniques; Diagnóstico precoz; Early diagnosis; Equipos de respuesta rápida; Herramientas de decisión clínica; Hospital rapid response team; Momento de ingreso; Outcome; Pronóstico; Time admission.