• Uchenna R Ofoma, Juan Montoya, Debdoot Saha, Andrea Berger, H Lester Kirchner, John K McIlwaine, and Shravan Kethireddy.
• Division of Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, USA. Electronic address: uofoma@wustl.edu.
• J Crit Care. 2020 Aug 1; 58: 48-55.

PurposeHospital occupancy (HospOcc) pressures often lead to longer intensive care unit (ICU) stay after physician recognition of discharge readiness. We evaluated the relationships between HospOcc, extended ICU stay, and patient outcomes.Materials And Methods7-year retrospective cohort study of 8500 alive discharge encounters from 4 adult ICUs of a tertiary hospital. We estimated associations between i) HospOcc and ICU transfer delay; and ii) ICU transfer delay and hospital mortality.ResultsMedian (IQR) ICU transfer delay was 4.8 h (1.6-11.7), 1.4% (119) suffered in-hospital death, and 4% (341) were readmitted. HospOcc was non-linearly related with ICU transfer delay, with a spline knot at 80% (mean transfer delay 8.8 h [95% CI: 8.24, 9.38]). Higher HospOcc level above 80% was associated with longer transfer delays, (mean increase 5.4% per % HospOcc increase; 95% CI, 4.7 to 6.1; P < .001). Longer ICU transfer delay was associated with increasing odds of in-hospital death or ICU readmission (odds ratio 1.01 per hour; 95% CI 1.00 to 1.01; P = .04) but not with ICU readmission alone (OR 1.01 per hour; 95% CI 1.00 to 1.01, P = .14).ConclusionsICU transfer delay exponentially increased above a threshold hospital occupancy and may be associated with increased hospital mortality.Copyright © 2020 Elsevier Inc. All rights reserved.

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