Triage Decision for ICU Admission and Patients' Outcome

Lee, Jae Hoon; Shin, Cheung Soo; Han, Sol; Koh, Shin Ok

Abstract

BACKGROUND: We constructed a prospective study to evaluate the outcome of patients referred to an intensivist for ICU admission as well as the factors associated with ICU admission refusal.
METHODS
Patients referred for ICU admission to medico-surgical ICU in our hospital for 16 weeks were included in this study. We classified the reasons for refusal into three categories: inappropriate referral; triage; futility. Also we classified admitted patients into two categories: immediate admission; delayed admission. After initial evaluation of a patient by an intensivist, we checked the patient's outcome for following 28 days.
RESULTS
632 patients had been referred for ICU admission during study period. Among them, 445 (70%) patients were admitted and 187 (30%) patients were refused ICU admission. 116 patients were refused because of inappropriate referral, 52 for triage and 19 for futility. 394 patients were admitted immediately and 51 were refused initially but were later admitted. When 116 inappropriate referral patients were excluded, the mortality rates for immediate admission, delayed admission and triage/futility were 14.4%, 39.2% and 56.3%, respectively (P<0.05). Standardized mortality ratio was 0.70 for immediate admission, 1.20 for delayed admission, 1.28 for triage and 1.30 for futility (P<0.05). The factors associated with refusal for ICU admission were age, medical division, diagnostic group and high Mortality Probability Model II0 (MPM II0) grades.
CONCLUSIONS
Because the triage decision for ICU admission influences the patients' outcome, an intensivist must carefully come to a decision when admitting patients to ICU by considering the appropriate guidelines for ICU admission and triage.