ICU room assignment can affect survival

NEW YORK (Reuters Health) - For the very sickest patients in an intensive care unit (ICU), being assigned to a room that can't easily be seen from the central nursing station might lower the chances of survival.

"Very sick patients require close monitoring by healthcare professionals," Dr. Phillip H. Factor from Beth Israel Hospital, New York, told Reuters Health by email. "Relying on electronic monitors is not sufficient in the sickest of the sick; these patients require direct observation."

Factor was the senior researcher on a study of 664 patients in a medical ICU (as opposed to a surgical ICU). Roughly two-thirds of the patients were assigned to rooms with unimpeded visibility from the central nursing station. The remaining third were in corner rooms that couldn't be seen clearly from the nurses' station.

In the journal Chest, Factor and his coauthors report that overall, there was no difference in survival rates between patients in the rooms with good visibility and those that couldn't be seen as easily.

The researchers also considered whether the severity of patients' illnesses affected their risk in the different rooms. They used a standard tool known as the APACHE II score to judge how sick the patients were.

They found that the very sickest individuals - those with APACHE II scores above 30 - had a higher likelihood of dying while in the ICU, or while still in the hospital, if they were assigned to a low-visibility ICU room. This was true no matter what disease they were hospitalized for.

Why more deaths occurred among severely ill patients in the low-visibility rooms isn't clear yet. "Whether they are due to late identification of...deterioration or less time spent by healthcare providers at the bedside or other undiscovered variables is unknown and requires additional study," the authors wrote.

In a phone call with Reuters Health, the lead author, Dr. David Leaf from Columbia University College of Physicians and Surgeons in New York City emphasized, "This is the first article that addresses this issue, so the results should be interpreted cautiously."

But, Leaf continued, "It's both intuitive and now supported by some evidence that corner rooms with low visibility may be associated with poorer outcomes and therefore should be avoided whenever possible in the case of extremely sick patients."

His colleague Dr. Factor pointed out that some ICUs may have special routines in place to improve the care of patients in lower-visibility rooms, such as increased nurse-to-patient ratios.

Even so, Leaf said, in the case of extremely sick patients, "if there is an empty room closer to the nurses' station, it wouldn't be unreasonable to ask to have the patient moved."

SOURCE: Chest, January 15, 2010.