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J Crit Care. 2010 Jun;25(2):205-13. doi: 10.1016/j.jcrc.2009.06.010. Epub 2009 Aug 13.

A model for identifying patients who may not need intensive care unit admission.

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1
The Department of Anesthesia and Critical Care Medicine, George Washington University, Washington, DC, USA.

Abstract

PURPOSE:

This study presents a new model for identifying patients who might be too well to benefit from intensive care unit (ICU) care.

PATIENTS AND METHODS:

Intensive care unit admissions in 2002 to 2003 were used to develop a model to predict whether patients monitored on day one would receive one or more of 33 subsequent active life-supporting treatments. Accuracy was assessed by testing the model in a subsequent cohort of admissions in 2004 to 2006. We then assessed the frequency of active treatment among monitor patients at a low (<10%) risk for active life-supporting therapy on ICU day 1.

RESULTS:

Among 28 847 ICU monitor admissions in 2004 to 2006, 3153 patients (11.0%) were predicted to receive active treatment; 3296 (11.5%) actually did. There were 17 720 admissions with a low (<10%) risk for receiving subsequent active life-supporting treatment; 1238 (7.0%) received subsequent active treatment. Hospital mortality (2.5%) and mean ICU stay (1.8 days) suggests that most of these patients did not require ICU care.

CONCLUSIONS:

The outcome for low-risk monitor patients suggest they may be too well to benefit from intensive care. The frequency of low-risk monitor admissions provides a measure of ICU resource use. Improved resource use and reduced costs might be achieved by strategies to provide care for these patients on floors or intermediate care units.

PMID:
19682848
DOI:
10.1016/j.jcrc.2009.06.010
[Indexed for MEDLINE]
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