Educational Material

The Importance of Estimating a Patient’s ICU Length of Stay

 

Why estimate the length of stay at an ICU?

In a scenario where there is increasing pressure to increase efficiency in the hospital sector, safely reducing hospitalization times, especially for ICU patients, is a strategy that has been widely recommended. To properly implement this strategy, it is essential to accurately estimate the length of hospitalization. Generating estimates can be useful for a range of measures, such as: Identifying long-term high-risk patients and implementing specific plans of care for such; Estimate and planning ICU care capacity and flow (vacancies for elective surgeries and patient transfers); Allow benchmarking through risk-adjusted measures, thus comparing, in a fair way, the average length of stay between different ICUs.

What is a long-term stay at an ICU?

The current definitions of long-term stay vary (seven, ten, or 14 days) according to the profile of the units and patients. However, we believe that this logic is not about correctly evaluating what is in fact a long stay since the main diagnosis of the patient substantially influences the definition of what would be appropriate or normal. As an example, we can imagine that an eight-day ICU stay is long for a patient in the postoperative period of myocardial revascularization surgery, in which the average is three days, but not for a patient with community-acquired pneumonia, where the average period is eight days. Considering a database of more than two million patients, we used a definition of long-term duration that is above the 90th percentile rate. With this, returning to the previous example, a patient in the postoperative period of myocardial revascularization would have a long stay when exceeding six days at an ICU, while a severe pneumonia community-acquired pneumonia would have over 15 days.

The benefits of estimating the length of stay at an ICU

What should be done when the patient has a significant risk of a long-term stay?

 

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