Evaluation of the patients refused admission into the intensive care unit: the lack of public beds

Introduction

In the past 5 years we have observed a progressive increase in nonmet demands of intensive care unit (ICU) beds. Most referrals to the ICU are emergencies or prebooked surgical cases. Some patients are refused admission because the units are full. The objective of this work is to identify the frequency of refused admission due to the lack of beds, the waiting time for admission, and the evolution of those patients.

Materials and methods

Data of all referrals consecutively made to the HURNP's ICU collected daily for a year (February 2002–February 2003) were collated. The referrals were categorized into clinical and surgical. The referrals criteria adopted was the hierarchy through a request order. The statistics was carried out through the EpiInfo program.

Results

Throughout the observation period 1210 referrals to the ICU were made, 43.7% of patients being immediately admitted. Out of 681 referrals initially refused, 49.8% of the surgical cases were admitted and 312 clinical referrals were refused because of the lack of beds. The surgical referrals made were major elective surgeries that were prebooked ranging from 1 to 7 days. Of all clinical patients initially refused, 11.9% were cancelled due to patients' clinical recovery; of the remaining 275 patients, 62.9% were admitted, 37.1% were never admitted into the ICU, and 8.4% died before an available bed. Of clinical patients later admitted into the ICU, 25% had a waiting time longer than 1 day. Their age median was 63.5 years (45–72 years), 60.1% being from the Emergency Room and the rest from the wards. Most clinical patients (24%) were diagnosed as having severe sepsis, and 31.8% were in mechanical ventilation when the referral was made. The mortality of patients admitted into the Emergency Room waiting for a bed in the ICU was no higher than those of the ward (P = 0.37).

Conclusion

In this population, 56.3% of the demand for ICU beds was not admitted immediately. The waiting time for admission ranged from 1 to 10 days. Fifty-five patients stayed longer than 1 day on mechanical ventilation outside the ICU. The mortality among the referrals expected to be about 60% was smaller then the ICU overall mortality (31.85%). This suggests that probably some patients reported as a ward evolution actually died. We suggest a study to analyse the need of adult ICU beds for this population, and the development of triage criteria.