Influence of ICU-bed availability on ICU admission decisions

Abstract

BackgroundThe potential influence of bed availability on triage to intensive care unit (ICU) admission is among the factors that may influence the ideal ratio of ICU beds to population: thus, high bed availability (HBA) may result in the admission of patients too well or too sick to benefit, whereas bed scarcity may result in refusal of patients likely to benefit from ICU admission.MethodsCharacteristics and outcomes of patient admitted in four ICUs with usual HBA, defined by admission refusal rate less than 11 % because of bed unavailability, were compared to patients admitted in six ICUs with usual low bed availability (LBA), i.e., an admission refusal rate higher than 10 % during a 90-day period.ResultsOver the 90 days, the mean number of days with no bed available was 30 ± 16 in HBA units versus 48 ± 21 in LBA units (p < 0.01). The proportion of admitted patients was significantly higher in the HBA (80.1 %; n = 659/823) than in the LBA units [61.6 %: n = 480/779; (p < 0.0001)]. The proportion of patients deemed too sick to benefit from admission was higher in LBA (9.0 %; n = 70) than in the HBA (6.3 %; n = 52) units (p < 0.05). The HBA group had a significantly greater proportion of patients younger than 40 years of age (22.5 %; n = 148 versus 14 %; n = 67 in LBA group; p < 0.001) and higher proportions of patients with either high or low simplified acute physiologic score II values.ConclusionsBed availability affected triage decisions. Units with HBA trend to admit patients too sick or too well to benefit.

A Decision Instrument to Identify Isolated Traumatic Subdural Hematomas at Low Risk of Neurologic Deterioration, Surgical Intervention, or Radiographic Worsening

“…Only a small portion of hospital beds are capable of critical care, and occupancy is high . Decreased ICU availability leads to downtriage of subsequent patients who may have substantial illness and who are shown to have increased mortality levels . Further, ICU admissions are costly: charges for 1 day in the ICU are three times greater than for 1 day on the general floor .…”

ICU beds: less is more? Yes

“…Yet, the preponderance of evidence suggests that ICU clinicians allocate intensive care services inefficiently as increased ICU bed availability leads to ICU care for those who may not need it. Several studies demonstrate a clear association between the number of available ICU beds and the likelihood that a patient will be admitted to an ICU [13,14]. For example, one study revealed that ICU's with high bed availability were much more likely to admit patients who were either too sick or too healthy to benefit from ICU care than ICU's with limited bed availability [13].…”

“…Several studies demonstrate a clear association between the number of available ICU beds and the likelihood that a patient will be admitted to an ICU [13,14]. For example, one study revealed that ICU's with high bed availability were much more likely to admit patients who were either too sick or too healthy to benefit from ICU care than ICU's with limited bed availability [13]. The abundance of ICU beds has led to indiscriminate use of ICU care-where critically ill and non-critically ill patients are granted ICU access in a first-come, first-served model until ICU beds become limited.…”

Rethinking the role of postoperative critical care in an inequitable world

“…On the other hand, too much of a good thing is not necessarily better. When Robert et al compared ICUs with usually high bed availability versus those with low bed availability, they observed that availability of more beds was associated with significantly more frequent admission of patients who were less likely to benefit from ICU care (those too well, or too sick to benefit) (6). Perhaps this is a reflection of human nature that when a resource is limited, we would think twice before utilizing it.…”