Compliance with intensive care admission guidelines on triage

Introduction

Appropriate utilization of expensive resources has become an important issue due to limited health budgets. Admission to the Intensive care unit (ICU) should be reserved for those patients with reversible medical conditions who have a 'reasonable prospect of substantial recovery' [1]. The Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine have introduced guidelines for prioritizing admission. These define those that will benefit most from ICU (Priority 1) to those that will not benefit at all (Priority 4).We aimed to test our compliance to the model and to critically analyze its usefulness as a triage tool.

Method

We performed a prospective audit of all adult referrals for admission to our 22 bed multidisciplinary University ICU between 13 November and 13 December 2001. Patients were categorized according to the guidelines by two investigators not involved in the triage decision. The proportion of patients admitted in each priority group was calculated.

Results

The audit consisted of 117 patients. The mean age was 58 and the mean Mortality Prediction Model at admission (MPM II₀) 0.37. The results obtained are shown in the Table 1.

Table 1

Conclusion

Our triage decisions complied well with the guidelines. This is evident from the high admission rate in the Priority 1 group and a reducing admission rate in the subsequent categories. Due to our limited health resources some category 1 patients were refused. In healthcare systems with limited resources a method of selecting between category 1 patients may be necessary.