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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 November;78(11):1226-33
Admission decisions to a Medical Intensive Care Unit are based on functional status rather than severity of illness. A single center experience
Cohen R. I. 1, 3, Eichorn A. 2, Silver A. 4 ✉
1 Division of Pulmonary, Critical Care and Sleep Medicine, New Hyde Park, NY, USA;
2 Krasnoff Quality Management Institute, Great Neck, NY, USA;
3 Hofstra University School of Medicine, New Hyde Park, NY, USA;
4 Island Peer Review Organization, Lake Success, NY, USA
BACKGROUND: Few data exist on Medical Intensive Care Unit (MICU) triage practices. We assessed MICU triage practices in our medical center.
METHODS: We collected data on all MICU consultations for one year, including each patient’s APACHE II score at time of consultation. We assessed functional impairment at baseline and at time of MICU consultation.
RESULTS: A total of 54% out of 572 consultations resulted in admission. Patients were less likely to be admitted if baseline functional status was poor (OR, 0.29; 95% CI 0.17-0.50), if a do-not-resuscitate order was present (OR, 0.44; 95% CI, 0.21-0.89), and if the MICU attending spent more than 25% of professional time in MICU (OR, 2.44; 95% CI, 1.37-4.32). Patients were more likely to be admitted if functional status at time of MICU consultation was poor (OR, 2.30; 95% CI 1.46-3.48). Patients’ age, insurance, ethnicity, severity of illness, presence of malignancy, or whether patient’s primary physician was on staff were not independently associated with MICU admission decisions. MICU attendings rarely cited functional status as reason for MICU refusal on the consult forms.
CONCLUSION: MICU admission decisions are implicitly based on patients’ baseline functional status rather than severity of illness.