Medical Student McGill University McGill University Faculty of Medicine Laval, Quebec, Canada
Background: The timing of discharge of preterm infants born <33 weeks gestational age (GA) should be based on objective clinical criteria. In a public funded regionalized healthcare system with limited number of beds, external factors such as neonatal intensive care unit (NICU) bed occupancy may contribute to the timing of discharge of these infants. We aimed to assess the association of NICU occupancy with probability of patient discharge and length of stay.
Design/Methods: Multicenter retrospective cohort study of infants born 23-32 weeks GA without major congenital anomaly, admitted to one of five Level 3 NICUs in Quebec, Canada (2014-2018) and discharged alive. Patient data is obtained from the Canadian Neonatal Network database and combined to unit occupancy data from a provincial administrative database. Unit occupancy at time of discharge of each patient was calculated as mean unit occupancy of the two days before and the morning of discharge (for statistical smoothing of exposure). Daily unit occupancy was divided into quintiles, and standardized ratios of observed to expected discharges were calculated. Multivariable linear regression models were used to assess the association between occupancy and length of stay.
Results: Among 3822 infants included in analyses, 2144 (63%) were born <29 weeks GA (Table1). Median length of stay was 50 days (IQR 28-85). Median NICU occupancy during the study period was 88% (IQR 80-95%). Unit occupancy quintiles correlated with probability of discharge (rs=0.69,p<0.01). When unit occupancy was in the lowest quintiles (Q1 and Q2) infants were 13% and 11% less likely to be discharged (Figure1). At higher unit occupancy quintiles (Q5), infants were 20% more likely to be discharged. Subgroup analysis by GA group (<29 weeks, 29-32 weeks) showed similar results among infants 29-32 weeks but no significant associations among infants <29 weeks. High occupancy (Q5) prior to discharge was also associated with 5.1-day (95% CI 2.1,8.2) reduction in LOS compared to low occupancy (Q1) (Table2). Conclusion(s): In a regionalized healthcare system, NICU occupancy was associated with timing of discharge of very preterm infants born <33 weeks, suggesting that providers integrate organizational variables in their clinical decision-making for discharge planning. This association was mainly attributable to the sub-group of infants born 29-32 weeks suggesting that reductions in length of stay could be possible in this sub-group but not among infants <29 weeks.
Authors/Institutions: Elyonora Sargi, McGill University Faculty of Medicine, Montreal, Quebec, Canada; Marc Beltempo, Montreal Children's Hospital, Montreal, Quebec, Canada; Sharina Patel, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Bruno Piedboeuf, Universite Laval Faculte de medecine, Quebec City, Quebec, Canada; Anie Lapointe, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada; Sharon Taylor-Ducharme, McGill University Health Centre, Montreal, Quebec, Canada; Stéphane Morin, Centre integre universitaire de sante et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke du Quebec, Sherbrooke, Quebec, Canada