Refusal of ICU Admission Due to a Full Unit: Impact on Mortality.
Am J Respir Crit Care Med. 2012 Feb 16;
Authors: Robert R, Reignier J, Tournoux-Facon C, Boulain T, Lesieur O, Gissot V, Souday V, Hamrouni M, Chapon C, Gouello JP,
RATIONALE: Intensive-care-unit (ICU) beds are a scarce resource, and patients denied intensive care only because the unit is full may be at increased risk of death. OBJECTIVE: To compare mortality after first ICU referral in admitted patients and in patients denied admission because the unit was full. METHODS: Prospective observational multicenter cohort study of consecutive patients referred for ICU admission during two 45-day periods, conducted in 10 ICUs. MEASUREMENTS AND MAIN RESULTS: Of 1762 patients, 430 were excluded from the study, 116 with previously denied admission to another ICU and 270 because they were deemed too sick or too well to benefit from ICU admission. Of the remaining 1332 patients, 1139 were admitted and 193 were denied admission because the unit was full (65 were never admitted, 39 were admitted after bumping of another patient, and 89 were admitted upon subsequent referral). Crude day-28 and day-60 mortality rates in the nonadmitted and admitted groups were 30.1% vs. 24.3%, p=0.07 and 33.3% vs. 27.2%, p=0.06, respectively. Day-28 mortality adjusted on age, previous disease, Glasgow scale score ?8, shock, creatinine level ?250 µmol/L, and prothrombin time ?30 sec was nonsignificantly higher in patients refused ICU admission only because of a full unit, compared to patients admitted immediately. Patients admitted after subsequent referral had higher mortality rates on day 28 (p=0.05) and day 60 (p=0.04) compared to directly admitted patients. CONCLUSIONS: Delayed ICU admission due to a full unit at first referral is associated with increased mortality.
PMID: 22345582 [PubMed - as supplied by publisher]
What is your institution’s policy on accepting or refusing ICU admissions? Do you feel that your ICU is large enough to accommodate demand?