Caring for critically ill patients outside intensive care units due to full units: a cohort study

Abstract

OBJECTIVES:This study sought to analyze the clinical and epidemiologic characteristics of critically ill patients who were denied intensive care unit admission due to the unavailability of beds and to estimate the direct costs of treatment.METHODS:A prospective cohort study was performed with critically ill patients treated in a university hospital. All consecutive patients denied intensive care unit beds due to a full unit from February 2012 to February 2013 were included. The data collected included clinical data, calculation of costs, prognostic scores, and outcomes. The patients were followed for data collection until intensive care unit admission or cancellation of the request for the intensive care unit bed. Vital status at hospital discharge was noted, and patients were classified as survivors or non-survivors considering this endpoint.RESULTS:Four hundred and fifty-four patients were analyzed. Patients were predominantly male (54.6%), and the median age was 62 (interquartile range (ITQ): 47 - 73) years. The median APACHE II score was 22.5 (ITQ: 16 - 29). Invasive mechanical ventilation was used in 298 patients (65.6%), and vasoactive drugs were used in 44.9% of patients. The median time of follow-up was 3 days (ITQ: 2 - 6); after this time, 204 patients were admitted to the intensive care unit and 250 had the intensive care unit bed request canceled. The median total cost per patient was US$ 5,945.98.CONCLUSIONS:Patients presented a high severity in terms of disease scores, had multiple organ dysfunction and needed multiple invasive therapeutic interventions. The study patients received intensive care with specialized consultation during their stay in the hospital wards and presented high costs of treatment.

Predictors of Mortality and Outcomes of Ventilated Patients Managed in a Resource‐Limited Acute Surgical Ward

“…1 ). Consistent with the evidence of higher survivability for patients who were admitted to ICU, [ 8 ] our series shows a survival rate of 54.5% if admitted to ICU against 17.5% when acute care was delivered in wards.…”

“…Cost-effective analysis in patients who were triaged to ICU admission based on survivability has been widely discussed, [ 8 ] which is the comparative cost of salvaging a patient’s recovery versus the cost expended in a futile case which ends in death. For this purpose of achieving maximum cost-effective benefit, multiple scoring systems have been devised, namely the Acute Physiologic Assessment and Chronic Health Evaluation.…”

Demand for Intensive Care beds and patient classification according to the priority criterion

“…A research study ( 19 ) with the purpose of analyzing the epidemiological and clinical characteristics of critically-ill patients who were denied admission to the ICU due to the unavailability of beds and estimating the direct costs of treatment during this period, identified prognostic scores, such as high values in Acute Physiology and Chronic Health Evaluation II(APACHEII), Sequential Organ Failure Assessment (SOFA) and Therapeutic Intervention Scoring System ( TISS), showing a high degree of organ dysfunction with the need for interventions that included the use of mechanical ventilation and vasoactive drugs, associated with high costs and unfavorable prognosis.…”

The Palliative Care Screening Tool as an instrument for recommending palliative care for older adults

“…The consequences of the situational diagnosis of palliative care in Brazil are: patients indicated for intensive care unit (ICU) admission being treated in wards, due to the lack of available beds, thus contributing to increased morbidity and mortality 4 , the use, for patients with severe chronic comorbidities, of technologies which will not change the outcome and which increase the physical and psychological distress of patients and their families, resulting in the deterioration of the quality of death of the individual. The Economist magazine was emphatic in this regard when it assessed, in 2015, the quality of death in 80 countries, with Brazil ranking 42 nd behind Chile (27 th ), Costa Rica (29 th ), Panama (31 st ), Argentina (32 nd ), Uruguay (39 th ), South Africa (34 th ), Uganda (35 th ), Mongolia (28 th ) ) and Malaysia (38 th ) 5 .…”