ICU Admission,

Discharge &
Triage
Guidelines
 The “Expensive” Care Unit

• USA :*)
- 20-28% of total inpatient costs
- 16-38,4% of hospital costs
• 1 ICU day = 3 to 6 times non-ICU day
• Higher cost in non-survivors
• ICU resources are finite

The appropriate utilization of ICU beds is essential, but it is

complex and a challenge to attain

*)Coopersmith CM, et al : A comparasion of critical are research funding and the financial burden of crtical illnes in the United
States. Crit Care Med 2012
ICU Admission
Criteria

A service for patients with

potentially recoverable conditions
who can benefit from more
detailed observation and invasive
treatment than can be safely
provided in general wards or high
dependency areas.
 ICU Triage
● Triage is the process of placing
patients at their most appropriate level
of care, based upon their need for
medical treatment and the assessment
that they will benefit from ICU care.

● demand for ICU services exceeds

supply

● rationing of ICU beds is common

01.
ICU
Admission
ICU Admission Criteria
• Potential or established organ failure
• Factors to be considered
ü Diagnosis
ü Severity of illness
ü Age and functional status
ü Co-existing disease
ü Prognosis
ü Availability of suitable treatment
ü Response to treatment to date
ü Recent cardiopulmonary arrest
ü Anticipated quality of life
ü The patient’s wishes
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Care in the ICU Versus Intensive Care in the Wards
Recommendations:
• We suggest that patients with invasive mechanical ventilation or complex life-
threatening conditions, including those with sepsis, be treated in an ICU. Patients
should not be weaned from mechanical ventilation on the general ward unless the
ward is a high-dependency/intermediate unit (grade 2C).

• We suggest that critically ill patients in the ED or on the general ward be transferred
to a higher level of care, such as the ICU, in an expeditious manner (grade 2D)
• There is an increased risk of cardiac arrest for sicker ward patients when medical
ICU beds are not available and increased risk of mortality and ICU length of stay
(LOS) if there is a delay in admitting a critically ill patient from the hospital ward to
the ICU
• A delay of 4 hours or more in transferring patients from the hospital ward to the ICU
was associated with a significant increase in mortality in a hospital.
• Young et al found that patients who were rapidly transferred to the ICU after
identification of a problem (rapid transfers) had a hospital mortality rate of 11%,
whereas those who arrived in the ICU after 4 hours (slow transfers) had a hospital
mortality rate of 41% (relative risk [RR], 3.5; 95% CI, 1.4–9.5; p = 0.004).

Young MP, Gooder VJ, McBride K, et al: Inpatient transfers to the intensive care unit: Delays are associated with
increased mortality and morbidity. J Gen Intern Med 2003
02.
ICU
TRIAGE
In general, patients admitted to the ICU should meet one or
more of the following criteria:
• Require care involving specialized competency of ICU staff that is not widely
available elsewhere in the hospital (e.g., invasive mechanical ventilation,
management of shock, extracorporeal membrane oxygenation, and intraaortic
balloon pump).
• Have clinical instability (e.g., status epilepticus, hypoxemia, and hypotension).
• Be at high risk for imminent decline (e.g., impending intubation)
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03.
ICU
Discharge
THANK YOU