Accepted for/Published in: JMIR Perioperative Medicine
Date Submitted: Apr 26, 2019
Open Peer Review Period: Apr 30, 2019 - May 25, 2019
Date Accepted: Jul 22, 2019
(closed for review but you can still tweet)
Impact of an intensive care information system on the length of stay of surgical ICU patients: an observational study
ABSTRACT
Background:
The implementation of computerized monitoring and prescription systems has proven to be reliable, to reduce the rate of medical error and to increase the patient care time. It has been suggested that it could also bring a benefit in reducing the length of stay, but this potential benefit has been poorly studied in ICU, with conflicting results. Thus, our objective was to explore the impact of computerization on ICU length of stay.
Objective:
Explore the impact of computerization on ICU length of stay.
Methods:
This was a before-after single-centre retrospective observational study. All patients admitted in the surgical ICU of a tertiary care hospital were included, from June 1st, 2015 to June 1st, 2016 for the before period and from August 1st, 2016 to August 1st, 2017 for the after period. The data were extracted from the hospitalization report and included: epidemiological data (age, sex, weight, height and body mass index), reason for ICU admission, severity score at admission, length of stay and mortality in ICU, mortality in hospital, use of life support during the stay and ICU re-admission during the same hospital stay. The consumption of antibiotics, biological analyses and the number of chest x-rays during the stay were also analysed.
Results:
A total of 1600 patients were included: 839 in the before period and 761 in the after period. Only the severity score SAPS II was significantly higher in the post- computerization period (38 ± 20 vs. 40 ± 21, P<0.05). There was no significant difference in terms of length of stay in ICU (7.0 ± 9.3 days before vs. 7.4 ± 9.9 days after, P = 0.37), ICU mortality rate (16.6% before vs. 16.8% after, P = 0.89), or re-admission rate during the stay (7% before vs. 7.9% after, P = 0.57). Despite less patient in the after group, there was a higher cost and consumption of biological analyses in the post-computerization period (5,416 [5,192-5,956] analyses/month before vs. 6,374 [6,013-6,986] analyses/months after, P = 0.002; and 28,503 [25,531-29,270] €/month before vs. 32,530 [30,222-35,973] €/month after, P = 0.01). There was also a trend towards reduction in the average number of chest x-rays, but this was not significant (0.55 ± 0.39 chest x-rays/day/patient before computerization versus 0.51 ± 0.37 chest x-rays/day/patient after computerization; P=0.054).
Conclusions:
Implementation of an intensive care information system did not have any impact on reducing the length of stay in our ICU. Our results reinforces the idea that computerized monitoring has few or no impact on ICU length of stay.
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