• David V Pilcher, Tamishta Hensman, Shailesh Bihari, Michael Bailey, Jason McClure, Mark Nicholls, Shaila Chavan, Paul Secombe, Melissa Rosenow, Sue Huckson, and Edward Litton.
• The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Prahran, VIC, Australia.
• Crit. Care Med. 2023 Dec 1; 51 (12): 162316371623-1637.

ObjectivesICU resource strain leads to adverse patient outcomes. Simple, well-validated measures of ICU strain are lacking. Our objective was to assess whether the "Activity index," an indicator developed during the COVID-19 pandemic, was a valid measure of ICU strain.DesignRetrospective national registry-based cohort study.SettingOne hundred seventy-five public and private hospitals in Australia (June 2020 through March 2022).SubjectsTwo hundred seventy-seven thousand seven hundred thirty-seven adult ICU patients.InterventionsNone.Measurements And Main ResultsData from the Australian and New Zealand Intensive Care Society Adult Patient Database were matched to the Critical Health Resources Information System. The mean daily Activity index of each ICU (census total of "patients with 1:1 nursing" + "invasive ventilation" + "renal replacement" + "extracorporeal membrane oxygenation" + "active COVID-19," divided by total staffed ICU beds) during the patient's stay in the ICU was calculated. Patients were categorized as being in the ICU during very quiet (Activity index < 0.1), quiet (0.1 to < 0.6), intermediate (0.6 to < 1.1), busy (1.1 to < 1.6), or very busy time-periods (≥ 1.6). The primary outcome was in-hospital mortality. Secondary outcomes included after-hours discharge from the ICU, readmission to the ICU, interhospital transfer to another ICU, and delay in discharge from the ICU. Median Activity index was 0.87 (interquartile range, 0.40-1.24). Nineteen thousand one hundred seventy-seven patients died (6.9%). In-hospital mortality ranged from 2.4% during very quiet to 10.9% during very busy time-periods. After adjusting for confounders, being in an ICU during time-periods with higher Activity indices, was associated with an increased risk of in-hospital mortality (odds ratio [OR], 1.49; 99% CI, 1.38-1.60), after-hours discharge (OR, 1.27; 99% CI, 1.21-1.34), readmission (OR, 1.18; 99% CI, 1.09-1.28), interhospital transfer (OR, 1.92; 99% CI, 1.72-2.15), and less delay in ICU discharge (OR, 0.58; 99% CI, 0.55-0.62): findings consistent with ICU strain.ConclusionsThe Activity index is a simple and valid measure that identifies ICUs in which increasing strain leads to progressively worse patient outcomes.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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