IS THERE A RELATIONSHIP BETWEEN THE VOLUME OF WORK CARRIED OUT IN INTENSIVE-CARE AND ITS OUTCOME

This paper reports the results of a study of the association between v olume of activity and patient outcome in 26 intensive care units in th e United Kingdom. Hospital fatality rates showed a statistically signi ficant (p = .016) negative association with volume. However, mean APAC HE II scores, as a measure of the severity of case mix, were also nega tively associated with volume (p = .021). Thus, one explanation of the lower death rates at higher volumes is that larger units admit less s everely ill patients. For patients admitted im med lately after surger y, 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.