The intensive care unit volume–mortality relationship, is bigger better? An integrative literature review

Abbenbroek, Brett; Duffield, Christine; Elliott, Doug

doi:10.1016/j.aucc.2014.02.001

Cited by 13 publications

(7 citation statements)

References 47 publications

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“…Therefore, a direct comparison between groups were inappropriate. Other studies have suggested that there may be a threshold beyond which mortality benefit is lost with increased case volume 2930. In addition, diagnosis also seems to be a factor as risk-adjusted mortality was decreased in patients within the same diagnostic category as hospital volume increased 31…”

Section: Discussionmentioning

confidence: 99%

Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

et al. 2019

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Background The purpose of this study was to evaluate whether institutional case volume affects clinical outcomes in patients receiving mechanical ventilation for 48 hours or more. Methods We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 158,712 adult patients were included at 55 centers in Korea. Centers were categorized according to the average annual number of patients: > 500, 500 to 300, and < 300. Results In-hospital mortality rates in the high-, medium-, and low-volume centers were 32.6%, 35.1%, and 39.2%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio [OR], 1.332; 95% confidence interval [CI], 1.296–1.368; P < 0.001) and medium-volume centers (adjusted OR, 1.125; 95% CI, 1.098–1.153; P < 0.001) compared to high-volume centers. Long-term survival for up to 8 years was better in high-volume centers. Conclusion Centers with higher case volume (> 500 patients/year) showed lower in-hospital mortality and long-term mortality, compared to centers with lower case volume (< 300 patients/year) in patients who required mechanical ventilation for 48 hours or more.

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Section: Discussionmentioning

confidence: 99%

Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

et al. 2019

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“…Categorization of continuous data does avoid the presumption of any mathematical relationship, but can obscure associations and prevent deep understanding of data [ 41 – 43 ]. Prior research has shown that the volume–outcome relationship in surgery can be linear, stepwise, curvelinear or U-shaped, for example [ 44 – 47 ], and this requires further elucidation for dialysis.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of the impact of center volume in dialysis

2015

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BackgroundA significant relationship exists between the volume of surgical procedures that a given center performs and subsequent outcomes. It seems plausible that such a volume–outcome relationship is also present in dialysis.MethodsMEDLINE and EMBASE were searched in November 2014 for non-experimental studies evaluating the association between center volume and patient outcomes [mortality, morbidity, peritonitis, switch to hemodialysis (HD) or any other treatment], without language restrictions or other limits. Selection of relevant studies, data extraction and critical appraisal were performed by two independent reviewers. We did not perform meta-analysis due to clinical and methodological heterogeneity (e.g. different volume categories).Results16 studies met out inclusion criteria. Most studies were performed in the US. The study quality ranged from fair to good. Only few items were judged to have a high risk of bias, while many items were judged to have an unclear risk of bias due to insufficient reporting. All 10 studies that analyzed peritoneal dialysis (PD) technique survival by modeling switch to HD or any other treatment as an outcome showed a statistical significant effect. The relative effect measures ranged from 0.25 to 0.94 (median 0.73) in favor of high volume centers. All nine studies indicated a lower mortality for PD in high volume centers, but only study was statistical significant.ConclusionsThis systematic review supports a volume–outcome relationship in peritoneal dialysis with respect to switch to HD or any other treatment. An effect on mortality is probably present in HD. Further research is needed to identify and understand the associations of center volume that are causally related to patient benefit.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1785-5) contains supplementary material, which is available to authorized users.

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“…Higher acuity patients in Unit 1 with less qualified and less experienced nurses had lower nurse-patient workload ratios that in turn meant mortality was comparable to Unit 2 where lower acuity patients were cared for by a more experienced and educated critical care nursing workforce with higher nurse-to-patient ratio. A volume threshold where risk-adjusted mortality benefit can tip indicates there is a window, regulated by high and low volumes, in which optimal ICU performance exists (Abbenbroek et al, 2014).…”

Section: Icu Nurse Staffing and Mortalitymentioning

confidence: 99%

Workforce management and patient outcomes in the intensive care unit during the COVID‐19 pandemic and beyond: a discursive paper

Wynne

Davidson

Duffield

et al. 2021

Journal of Clinical Nursing

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Aims:To highlight the need for the development of effective and realistic workforce strategies for critical care nurses, in both a steady state and pandemic.Background: In acute care settings, there is an inverse relationship between nurse staffing and iatrogenesis, including mortality. Despite this, there remains a lack of consensus on how to determine safe staffing levels. Intensive care units (ICU) provide highly specialised complex healthcare treatments. In developed countries, mortality rates in the ICU setting are high and significantly varied after adjustment for diagnosis. The variability has been attributed to systems, patient and provider issues including the workload of critical care nurses. Design: Discursive paper.Findings: Nursing workforce is the single most influential mediating variable on ICU patient outcomes. Numerous systematic reviews have been undertaken in an effort to quantify the effect of critical care nurses on mortality and morbidity, invariably leading to the conclusion that the association is similar to that reported in acute care studies. This is a consequence of methodological limitations, inconsistent operational definitions and variability in endpoint measures. We evaluated the impact inadequate measurement has had on capturing relevant critical care data, and we argue for the need to develop effective and realistic ICU workforce measures. Conclusion:COVID-19 has placed an unprecedented demand on providing health care in the ICU. Mortality associated with ICU admission has been startling during the pandemic. While ICU systems have largely remained static, the context in which care is provided is profoundly dynamic and the role and impact of the critical care nurse needs to be measured accordingly. Often, nurses are passive recipients of unplanned and under-resourced changes to workload, and this has been brought into stark visibility with the current COVID-19 situation. Unless critical care nurses are engaged in systems management, achieving consistently optimal ICU patient outcomes will remain elusive.

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The intensive care unit volume–mortality relationship, is bigger better? An integrative literature review

Cited by 13 publications

References 47 publications

Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

Effect of Institutional Case Volume on In-Hospital and Long-Term Mortality in Critically Ill Patients Requiring Mechanical Ventilation for 48 Hours or More

A systematic review of the impact of center volume in dialysis

Workforce management and patient outcomes in the intensive care unit during the COVID‐19 pandemic and beyond: a discursive paper

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