BACKGROUND: Critical care resource use accounts for almost 1% of US gross domestic product and varies widely among hospitals. However, we know little about the initial decision to admit a patient to the intensive care unit (ICU). METHODS: To describe hospital ICU admitting patterns for medical patients after accounting for severity of illness on admission, we performed a retrospective cohort study of the first nonsurgical admission of 289,310 patients admitted from the emergency department or the outpatient clinic to 118 Veterans Affairs acute care hospitals between July 1, 2009, and June 30, 2010. Severity (30-day predicted mortality rate) was measured using a modified Veterans Affairs ICU score based on laboratory data and comorbidities around admission. The main outcome measure was direct admission to an ICU. RESULTS: Of the 31,555 patients (10.9%) directly admitted to the ICU, 53.2% had 30-day predicted mortality at admission of 2% or less. The rate of ICU admission for this low-risk group varied from 1.2% to 38.9%. For high-risk patients (predicted mortality >30%), ICU admission rates also varied widely. For a 1-SD increase in predicted mortality, the adjusted odds of ICU admission varied substantially across hospitals (odds ratio = 0.85-2.22). As a result, 66.1% of hospitals were in different quartiles of ICU use for low- vs high-risk patients (weighted κ = 0.50). CONCLUSIONS: The proportion of low- and high-risk patients admitted to the ICU, variation in ICU admitting patterns among hospitals, and the sensitivity of hospital rankings to patient risk all likely reflect a lack of consensus about which patients most benefit from ICU admission.
BACKGROUND: Critical care resource use accounts for almost 1% of US gross domestic product and varies widely among hospitals. However, we know little about the initial decision to admit a patient to the intensive care unit (ICU). METHODS: To describe hospital ICU admitting patterns for medical patients after accounting for severity of illness on admission, we performed a retrospective cohort study of the first nonsurgical admission of 289,310 patients admitted from the emergency department or the outpatient clinic to 118 Veterans Affairs acute care hospitals between July 1, 2009, and June 30, 2010. Severity (30-day predicted mortality rate) was measured using a modified Veterans Affairs ICU score based on laboratory data and comorbidities around admission. The main outcome measure was direct admission to an ICU. RESULTS: Of the 31,555 patients (10.9%) directly admitted to the ICU, 53.2% had 30-day predicted mortality at admission of 2% or less. The rate of ICU admission for this low-risk group varied from 1.2% to 38.9%. For high-risk patients (predicted mortality >30%), ICU admission rates also varied widely. For a 1-SD increase in predicted mortality, the adjusted odds of ICU admission varied substantially across hospitals (odds ratio = 0.85-2.22). As a result, 66.1% of hospitals were in different quartiles of ICU use for low- vs high-risk patients (weighted κ = 0.50). CONCLUSIONS: The proportion of low- and high-risk patients admitted to the ICU, variation in ICU admitting patterns among hospitals, and the sensitivity of hospital rankings to patient risk all likely reflect a lack of consensus about which patients most benefit from ICU admission.
Authors: Richard E Nelson; Vanessa W Stevens; Karim Khader; Makoto Jones; Matthew H Samore; Martin E Evans; R Douglas Scott; Rachel B Slayton; Marin L Schweizer; Eli L Perencevich; Michael A Rubin Journal: Am J Prev Med Date: 2016-05 Impact factor: 5.043
Authors: David J Wallace; Derek C Angus; Christopher W Seymour; Amber E Barnato; Jeremy M Kahn Journal: Am J Respir Crit Care Med Date: 2015-02-15 Impact factor: 21.405
Authors: Judith E Nelson; Kusum S Mathews; David E Weissman; Karen J Brasel; Margaret Campbell; J Randall Curtis; Jennifer A Frontera; Michelle Gabriel; Ross M Hays; Anne C Mosenthal; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; Stefanie P Weiss; Rick Bassett; Renee D Boss; Dana R Lustbader Journal: Chest Date: 2015-02 Impact factor: 9.410
Authors: Joanna L Hart; Michael O Harhay; Nicole B Gabler; Sarah J Ratcliffe; Caroline M Quill; Scott D Halpern Journal: JAMA Intern Med Date: 2015-06 Impact factor: 21.873
Authors: Wesley H Self; Carlos G Grijalva; Derek J Williams; Alison Woodworth; Robert A Balk; Sherene Fakhran; Yuwei Zhu; D Mark Courtney; James Chappell; Evan J Anderson; Chao Qi; Grant W Waterer; Christopher Trabue; Anna M Bramley; Seema Jain; Kathryn M Edwards; Richard G Wunderink Journal: Chest Date: 2016-04-21 Impact factor: 9.410
Authors: Laura C Feemster; Colin R Cooke; Gordon D Rubenfeld; Catherine L Hough; William J Ehlenbach; David H Au; Vincent S Fan Journal: Ann Am Thorac Soc Date: 2015-01