Shortage of ICU beds is a common issue in most ICUs and may decrease the likelihood of ICU admission, thus jeopardising equal rights and opportunities for patients to be admitted to the ICU. Previous studies have shown that, when fewer ICU beds are available, fewer patients are admitted and they are more severely ill.
In a descriptive prospective study by Orsini and colleges, 95 patients were evaluated for possible ICU admission during times of ICU overcrowding (defined as 2, 1, or no available ICU beds). The study was conducted at a general 12 bed ICU in Brooklyn, New York during April and May 2014.
The results showed that when no ICU beds were available, 33% of the patients evaluated for ICU admission were admitted to the ICU, 38% to a Step Down Unit (SDU), and 29% to hospital wards. With 1 bed available the percentages were 69% admitted to the ICU, 23% to SDU and 8% to hospital ward. With 2 beds available, 91% were admitted to the ICU, none to SDU and 9% to hospital ward.
Mean APACHE-II scores were 21.8 for the 33% of patients admitted to the ICU when no beds were available, 19.5 for the 69% admitted when 1 bed was available and 16.9 when 2 beds were available. Overall hospital mortality was 17.9%, while ICU mortality was 23.4%. Mortality was not presented separately for the different groups of patients.
Study Strengths & Limitations
A clear strength of this study is the prospective design evaluating patients consecutively.
Limitations of this study are the single-centre design, a lack of descriptions of actual reasons provided for denying admission to the ICU, and the lack of detailed outcome results.
Overall this study adds to the knowledge of triage difficulties when ICU beds are scarce and highlights the impact of decision-making when bed shortage is a factor. Additionally, this study suggests that Step Down Units may be a relevant alternative when ICU space is lacking.
This article review was submitted by ESICM Journal Review Club member Hanne Irene Jensen, on behalf of the Ethics Section.
Orsini J, Blaack C, Yeh A, Fonseca X, Helm T, Butala A, Morante J. Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage. J Clin Med Res 2014;6:463-8.