Why admit to icu

Using retrospective financial and medical record data, they have studied resource implications, outcomes and patient preferences. For this cohort of patients, treatment on the ICU is not only expensive, but its outcomes are poor.

Furthermore, a fifth of patients may have preferred treatment focused on their comfort rather than life-supporting measures [ 3 ]. Their findings support the assertion that if decision-making surrounding admission to the ICU could be improved, this would have objective benefits. It could save many patients from being subjected to treatments that do not help them, and could free available resources for patients who can both benefit from them and who would opt for this type of treatment.

How, then, to improve decision-making surrounding admission to the ICU and achieve these objective benefits? The first step, as in any other field of medical practice, is to understand and articulate effectively the processes and factors involved. Improving the nomenclature surrounding this process is an important first step. These definitions help to focus discussion and clarify thinking around these issues. Secondly, we need the right information to inform our decisions.

Initiatives such as the Eldicus project, which has developed statistics-based triage tools for patients referred to the ICU [ 5 ], may help: but statistical tools and quantitative outcome data alone cannot determine what is right for any individual. Outcomes relevant to each patient, their values and wishes must be taken into account. This can be a challenge when a patient cannot communicate effectively. Thirdly we must educate ourselves and design systems for best practice in decision-making.

In a working party of the World Federation of Societies of Intensive and Critical Care Medicine produced guidance on triaging patients to intensive care. They brought together evidence and expert opinion to address four important questions: who will benefit from intensive care; who makes the decision whether a patient should be admitted to intensive care; what in-hospital factors limit the ability to admit a patient to intensive care; and what other factors should influence whether or not a patient should be admitted to the ICU [ 7 ]?

These are undoubtedly valuable documents, and should be built upon to provide guidance for individual clinicians at the bedside. Standards and education in decision-making practice will protect and guide patients and clinicians when faced with these difficult clinical and ethical challenges.

Indeed, merely providing more resources may result in more waste and more harm to patients. In a study compared outcomes between units with high bed availability and low bed availability. The findings were that more beds may mean the admission of patients who are less likely to benefit from the ICU either because they are too well or too sick to benefit [ 10 ].

Our approach therefore must be different. We must develop standards and guidelines for decision-making surrounding intensive care admission as in any other part of our practice.

Decisions should be based on the best evidence, with clear reasoning, communication and review. We must educate future generations of intensivists so that they are better equipped to make such decisions, and we must design the systems to support high-quality decision-making practice. If we can do this while keeping the patient at the heart of our decision-making, and being clear as we articulate the rationale for each decision, then, as Chin-Yee and colleagues suggest, it may result in the objective benefits we seek.

Intensive Care Med. Intensive care unit bed availability and outcomes for hospitalized patients with sudden clinical deterioration. Arch Intern Med. Article PubMed Google Scholar. Cost analysis of the very elderly admitted to intensive care unit.

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Sign in with your library card Please enter your library card number. Disclaimer Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Top Previous Next Determinants of admission and discharge decisions Context Admission and discharge processes and outcomes vary widely between hospitals and between countries. Patient factors Decisions to admit patients to ICU or discharge them to the ward are determined by the severity of their illness.

Top Previous Next Decision support Scoring systems Physiological severity scoring, in particular the Acute Physiology and Chronic Health Evaluation APACHE system, was a transformational concept, introduced as a tool to characterize patient populations and to inform decision-making about individual patients. Patients that are being treated in general wards may find shifting to the ICU highly cumbersome.

Moreover, it can also expose the patient to the risk of bothersome, painful and sometimes potentially dangerous conditions. They are more likely to undergo harmful procedures and exposed to life-threatening infections.

It has been found that using the ICU to admit patients who do not need the ICUs unique services is a key source of inefficiency in our healthcare system. The intensive care unit of a hospital is usually where patients that are seriously ill, or those that require specialized care, are admitted. It is staffed by a specially trained staff that comprises of doctors, nurses, respiratory therapists, clinical nursing specialists, pharmacists, nurse practitioners, physician assistants, dietitians, social workers and others.

The equipment in the ICU may seem a little over-the-top at first glance, but each piece of machinery plays a crucial role in keeping the patient alive and healthy. There are machines to monitor the heart rate, blood pressure, ventilators to assist the patient in breathing, and many others.

The ICU also has special guidelines for visitors. Visitors may be requested to stay in the room of the patient they are visiting. They may also be requested to wait in the common waiting room during doctors rounds, for emergencies or during certain procedures. There are some patients who need very close monitoring, be it after a surgical intervention or even following an accident or a head injury.

When it comes to critical care of a patient, chances are that things can go either way very quickly. This makes monitoring the patient extremely crucial.

The critical deciding factor is the efficiency with which the oxygen is being supplied to the tissues depending upon their unique metabolic needs. This is crucial in order to fuel its mitochondrial respiration and therefore help the patient survive. Close monitoring is more often than not the best way to make sure that their health does not take a turn for the worse.

Patients whose lungs become inflamed because of injury or infection often find it difficult to breathe. This may require that they are put on ventilator support to help them breathe normally.

The inflammation in question often makes the small blood vessels leaky and allows fluid to collect in the lung tissues.