Rationing in the intensive care unit

Young, Michael J.; Brown, Sydney E. S.; Truog, Robert D.; Halpern, Scott D.

doi:10.1097/ccm.0b013e31822d750d

Cited by 22 publications

(14 citation statements)

References 69 publications

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“…Avoiding waste serves the interests of individual patients and society simultaneously, whereas rationing beneficial care entails tradeoffs between these interests (26, 27). To our knowledge, our study provides the most robust evidence to date that provision of critical care is not based solely on a clinician's assessment of individual patient needs.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Among Patients Discharged From Busy Intensive Care Units

Wagner¹,

Gabler²,

Ratcliffe³

et al. 2013

Ann Intern Med

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122

116

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Background Strains on the capacities of intensive care units (ICUs) may influence the quality of ICU-to-floor transitions. Objective To determine how 3 metrics of ICU capacity strain (ICU census, new admissions, and average acuity) measured on days of patient discharges influence ICU length of stay (LOS) and post–ICU discharge outcomes. Design Retrospective cohort study from 2001 to 2008. Setting 155 ICUs in the United States. Patients 200 730 adults discharged from ICUs to hospital floors. Measurements Associations between ICU capacity strain metrics and discharged patient ICU LOS, 72-hour ICU readmissions, subsequent in-hospital death, post–ICU discharge LOS, and hospital discharge destination. Results Increases in the 3 strain variables on the days of ICU discharge were associated with shorter preceding ICU LOS (all P < 0.001) and increased odds of ICU readmissions (all P< 0.050). Going from the 5th to 95th percentiles of strain was associated with a 6.3-hour reduction in ICU LOS (95% CI, 5.3 to 7.3 hours) and a 1.0% increase in the odds of ICU readmission (CI, 0.6% to 1.5%). No strain variable was associated with increased odds of subsequent death, reduced odds of being discharged home from the hospital, or longer total hospital LOS. Limitation Long-term outcomes could not be measured. Conclusion When ICUs are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly and, perhaps consequentially, have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected. These results suggest that bed availability pressures may encourage physicians to discharge patients from the ICU more efficiently and that ICU readmissions are unlikely to be causally related to patient outcomes. Primary Funding Source Agency for Healthcare Research and Quality; National Heart, Lung, and Blood Institute; and Society of Critical Care Medicine.

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Section: Discussionmentioning

confidence: 99%

Outcomes Among Patients Discharged From Busy Intensive Care Units

Wagner¹,

Gabler²,

Ratcliffe³

et al. 2013

Ann Intern Med

Self Cite

122

116

View full text Add to dashboard Cite

show abstract

“…Ideally, these decisions to limit treatment should be based on clear and consistently applied policies developed at the institutional, local or community level 78. Any decisions to prioritise patients and treatments should be fair and based on the patient's ability to benefit and should avoid discrimination, for example, race, age, gender, social status 79…”

Section: The Process Of Decision Makingmentioning

confidence: 99%

Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice:

Larcher

Craig

Bhogal³

et al. 2015

Arch Dis Child

211

206

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“…In such cases, decisions to repatriate patients might be considered justified, all things considered, if they promote efficient resource distributions. 17 Medical repatriation may be influenced by sociopolitical views. Animated by beliefs that repudiate the rights of undocumented persons to receive medical care by virtue of their inability to pay or their immigration status, policymakers, hospital administrators, or clinicians may find the practice of repatriation justified.…”

Section: Motivating Fac Tors -The Ne Xus Of C Are Cos T S and P Omentioning

confidence: 99%

“…Systems of concealed rules and actions enable discriminatory practices. 17,27 These realities indicate the great need for transparency and required reporting of medical repatriation. Requiring hospitals to be transparent about repatriation events, the reasons behind them, and the outcomes of repatriation can unmask the full scope of the practice, reveal areas of exceptional inequity, and enable the development of a fairer process, even if the practice is not discontinued.…”

Section: Trus T and Tr Ansparenc Ymentioning

confidence: 99%