The Factors Affecting the Length of Stay in the Intensive Care Unit

Length of stay in the intensive care unit (ICU) is one of the most important factors that impacts the health care resource utilization. The aim of this study was to identify the factors associated with prolonging the patients’ stay in Namazi Hospitals ICUs and perform possible interventions to reduce the length of stay in order to improve the quality of care and decrease hospital costs. During a two-month period, eight sessions were held with the senior physicians, head nurses and supervisors of eight adult ICUs working in Namazi hospital, a 850 bed university hospital in Shiraz, south of Iran. Factors that may contribute to the prolongation of patients' stay in the intensive care units were examined. Based on a researcher-made questionnaire, 28 important factors were identified and ranked according to the degree of importance. The most important factors in terms of the degree of importance were unavailable bed vacancy in the step down wards, financial problems of the families to pay for the home-based primary nursing cares, ICU acquired infections, and admission of the patients too sick to benefit from the ICU due to unjustified administrative pressure. The most amendable factors were hospital acquired infections, delay in surgical tracheostomy when indicated, unavailable bed in step down wards, and poor interdisciplinary collaboration of the staff physicians. Interventional projects have been designed to reduce the ICU-acquired infections, facilitating the process of surgical tracheostomy and supporting the families who are not able to pay the costs of home-based care.