Title: Impact of Severity-Adjusted Workload on Health Status of Patients Discharged from an ICU
Abstract: We examine whether workload has an impact on a direct measure of the health status of patients discharged from Intensive Care Units (ICUs). We use data collected from the medical ICU and the surgical ICU of a major teaching hospital and a relatively new measure of patient acuity called the Rothman Index (RI). The RI is frequently updated during a patient’s hospital stay, which enables us to track patients health status very close to the time of their ICU discharge. Leveraging the RI, we measure ICU workload in a novel way that takes into account not only the census but also patient acuity. To our knowledge, this is the first study to show that more acutely ill patients are discharged from an ICU when the severity-adjusted workload is high rather than low. Further, we find that higher severity-adjusted workload is associated with ICU discharge times that start earlier and end later, a shorter ICU length-of-stay (LOS), and an increased likelihood of discharge to a step-down unit. We also find that downstream unit census influences the effect of workload on health status at ICU discharge. We discuss possible interventions to reduce severity-adjusted workload. Joint work with Edieal Pinker, Joan Rimar, and Elizabeth Bradley.