Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-03T03:05:39.203Z Has data issue: false hasContentIssue false
  • English
  • Français

Is there a Relationship between the Volume of Work Carried Out in Intensive Care and its Outcome?

Published online by Cambridge University Press:  10 March 2009

Jeremy Jones  and
Kathy Rowan
Jeremy Jones
Affiliation:
London School of Hygiene and Tropical Medicine
Kathy Rowan
Affiliation:
University of Oxford and Radcliffe Infirmary
Get access Rights & Permissions [Opens in a new window]

Abstract

This paper reports the results of a study of the association between volume of activity and patient outcome in 26 intensive care units in the United Kingdom. Hospital fatality rates showed a statistically significant (p =.016) negative association with volume. However, mean APACHE II scores, as a measure of the severity of case mix, were also negatively associated with volume (p =.021). Thus, one explanation of the lower death rates at higher volumes is that larger units admit less severely ill patients. For patients admitted immediately after surgery, the correlation between severity standardized mortality ratios and volume (while not significant, p <.1) suggests there may be a volume-output effect unexplained by severity.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 11 , Issue 4 , Fall 1995 , pp. 762 - 769
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Black, N., & Johnson, A.Volume and outcome in hospital care: Evidence, explanations, and implications. Health Services Management Research, 1990, 3, 108–14.CrossRefGoogle ScholarPubMed
2.Burns, L. R., & Wholey, D. R.The effects of patient, hospital and physician characteristics on length of stay and mortality. Medical Care, 1991, 29, 251–71.CrossRefGoogle ScholarPubMed
3.Flood, A. B., Scott, W. R., & Ewy, W.Does practice make perfect? I: The Relation between hospital volume and outcomes for selected diagnostic categories. Medical Care, 1984, 22, 98–114.CrossRefGoogle Scholar
4.Hannan, E. L., O'Donnel, J. F., Kilburn, H. Jr., et al. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. Journal of the American Medical Association, 1989, 262, 503–10.CrossRefGoogle ScholarPubMed
5.Hughes, R. G., Garnick, D. W., Luft, H. S., et al. Hospital volume and patient outcomes: The case of hip fracture. Medical Care, 1988, 26, 1057–67.CrossRefGoogle ScholarPubMed
6.Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E.An evaluation of outcome from intensive care in major medical centers. Annals of Internal Medicine, 1986, 104, 410–18.CrossRefGoogle ScholarPubMed
7.Knaus, W. A., Draper, E. A., Wagner, D. P., & Zimmerman, J. E.APACHE II: A severity of disease classification system. Critical Care Medicine, 1985, 13, 818–29.CrossRefGoogle ScholarPubMed
8.Knaus, W. A., & Wagner, D. P.Interpretation of hospital mortality rates: The current state of art. Mayo Clinic Proceedings, 1990, 65, 1627–29.CrossRefGoogle Scholar
9.Luft, H. S., Hunt, S. S., & Maerki, S. C.The volume-outcome relationship: Practice-makes-perfect or selective-referral patterns? Health Services Research, 1987, 22, 157–82.Google ScholarPubMed
10.Marsh, H. M., Krishan, I., Naessens, J. M., et al. Assessment of prediction of mortality by using the APACHE II scoring system in intensive-care units. Mayo Clinic Proceedings, 1990, 65, 1549–57.CrossRefGoogle ScholarPubMed
11.Mayfield, J. A., Rosenblatt, R. A., Baldwin, L.-M., et al. The relation of obstetrical volume and nursery level to perinatal mortality. American Journal of Public Health, 1990, 80, 819–23.CrossRefGoogle ScholarPubMed
12.Rowan, K. M.Outcome comparisons of intensive care units in Great Britain and Ireland using the APACHE II method. DPhil Thesis, University of Oxford, 1992.Google Scholar
13.Rowan, K. M., Kerr, J.H., Major, E., et al. The Intensive Care Society's APACHE II Study in Britain and Ireland, I: Variations in the case-mix of adult admissions to general intensive care units and impact on outcome. British Medical Journal, 1993, 307, 972–77.CrossRefGoogle Scholar
14.Wagner, D., Draper, E., & Knaus, W.Analysis: Quality of care. Critical Care Medicine, 1989, 17, S210–12.CrossRefGoogle ScholarPubMed