PURPOSE: Adequate management of intensive care unit (ICU) beds is essential at a time of scarce healthcare resources; ICU triage has been recommended as a means to prioritize ICU beds. We evaluated a physician led Triage Service (TS) based on the Society of Critical Care Medicine guidelines to assist with the admission and discharge process of our 53-bed oncologic ICU. The TS covered weekdays from 7:30 AM to 10 PM.
METHODS: Data were collected on a standardized tracking tool twice/day (10 AM and 9 PM), and then recorded electronically from1/1/2009 to 12/31/2009. We documented ICU referrals and admissions, admitting services, sources and times of referral and admission, ICU and hospital census, tracked waiting lists, planned and unplanned admissions, admission priority categories, admission of non-ICU patients (dialysis and post-anesthesia overflow), and length of stay (LOS), among others. Only adult admissions were evaluated by the TS.
RESULTS: Of 2916 patients admitted to the ICU, 1939 arrived during the TS coverage period; 63% of them were triaged by the TS physician, and 14% of them were not admitted. The number of pending admissions at 10 AM and 9 PM was reduced by 38% and 65% respectively at the end of the study period. The number of patients waiting for ICU discharge was reduced by 35% at 10 AM, and by 47% at 9 PM. The percentage of patients prioritized on admission to category 1, 2, 3 and 4 were 75%, 25%, 3% and 1% respectively. The SICU LOS was reduced from a mean of 7 to 3.7 days; however, the MICU LOS increased from a mean of 5.2 to 6.8 days for an overall decrease mean ICU LOS of 0.5 days.
CONCLUSIONS: The ICU Triage Service had a major impact on ICU admission and discharge wait-times, as well as on SICU LOS.
CLINICAL IMPLICATIONS: Our results suggest that similar triage services may have a positive impact on resource allocation, and increase bed capacity by improving patient flow particularly in surgical ICUs.
DISCLOSURE: The following authors have nothing to disclose: Joseph Nates, Nisha Rathi, Sajid Haque, Susan Gaeta, Egbert Pravinkumar, Gregory Botz, Karen Chen, John Crommett, Donna Calabrese, Diego De Villalobos, Imrana Malik, Kristen Price
No Product/Research Disclosure Information