Rationing critical care beds: A systematic review*

Sinuff, Tasnim; Kahnamoui, Kamyar; Cook, Deborah J.; Luce, John M.; Levy, Mitchell M.

doi:10.1097/01.ccm.0000130175.38521.9f

Cited by 252 publications

(171 citation statements)

References 34 publications

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“…10,000 ICU bed triage decisions across North America, Europe, Israel, and Hong Kong, at least 15% of patients were refused ICU admission, of which approximately 15% were attributed to lack of beds. 9,29,30 Additionally, during times of ICU bed shortages, admitted patients were more ill at both ICU admission and discharge, average lengths of stay were shorter, and fewer patients were admitted for monitoring, which suggests that some patients are denied potentially benefi cial treatment in times of ICU bed shortages. 9 Some centers have attempted to reduce ICU use by making mechanical ventilation available on the wards.…”

Section: Empiric Data On Rationing In Icusmentioning

confidence: 99%

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The Ethics and Reality of Rationing in Medicine

Scheunemann

White

2011

Chest

198

174

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Health-care reform has remained a controversial sociopolitical issue for the last 2 decades. Part of the controversy at the policy level arises from the question of whether health-care reform will involve rationing medical care. This topic raises fears about unfair treatment of individuals, 1 which have been infl amed by assertions that rationing devalues human life. 2 Physicians have struggled with the controversy surrounding rationing. 3,4 Some deny that rationing occurs and contend that their professional obligations require them not to participate in rationing. [5][6][7] Others admit to rationing 8,9 and see just allocation of medical care as part of physicians' ethical duties. 10 Intensivists share this ambivalence. In a recent survey, only 60% vouched that they provide "every patient all benefi cial therapies without regard to costs." 11 To be thoughtful participants in the social debate about rationing in medicine, physicians must be well informed. The purpose of this article is to address the following topics: (1) the inevitability of rationing of social goods, including medical care; (2) types of rationing; (3) ethical principles and procedures for fair allocation; and (4) whether rationing ICU care to those near the end of life would result in substantial cost savings. What Is Rationing?Although rationing has been defi ned in slightly different ways by different groups, most defi nitions cluster around one central idea: denying a potentially benefi cial treatment to a patient on the grounds of scarcity. 12 The focus on potentially benefi cial Rationing is the allocation of scarce resources, which in health care necessarily entails withholding potentially benefi cial treatments from some individuals. Rationing is unavoidable because need is limitless and resources are not. How rationing occurs is important because it not only affects individual lives but also expresses society's most important values. This article discusses the following topics: (1) the inevitability of rationing of social goods, including medical care; (2) types of rationing; (3) ethical principles and procedures for fair allocation; and (4) whether rationing ICU care to those near the end of life would result in substantial cost savings.

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Section: Empiric Data On Rationing In Icusmentioning

confidence: 99%

“…3,4 Some deny that rationing occurs and contend that their professional obligations require them not to participate in rationing. [5][6][7] Others admit to rationing 8,9 and see just allocation of medical care as part of physicians' ethical duties. 10 Intensivists share this ambivalence.…”

mentioning

confidence: 99%

The Ethics and Reality of Rationing in Medicine

Scheunemann

White

2011

Chest

198

174

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“…These issues, the associated outcomes and the cascading effects of delayed admissions or discharges are making bed flow management an essential administrative responsibility among health authorities [1][2][3][4][5][6] . Timely information regarding bed availability is an immediate requirement to intelligently manage admission, discharge and transfers to and from ICUs.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…ICU beds are among the most valuable hospital resources for which demands periodically exceed supplies, resulting in rationing of such resource [2] . Several studies have evaluated the adverse outcomes associated with admission delay or refusal to admit to ICU due to bed unavailability [2][3][4][5] . Premature discharge from ICU to other care units or transfer to step-down units is a common response at times of high occupancy which is also reported to be associated with an increased risk of readmission or hospital mortality [6] .…”

Section: Introductionmentioning

confidence: 99%

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An on-line dashboard to facilitate monitoring of provincial ICU bed occupancy in Alberta, Canada

Shahpori

Gibney

Guebert

et al. 2013

JHA

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Intensive Care Unit (ICU) beds are among the most valuable hospital resources for which demands periodically exceed supplies. Hence monitoring and management of utilization of these resources is essential for providing an efficient and equitable service. The purpose of this article is to describe the design, development and utilization of a dashboard for the measurement of occupancy and management of capacity of a provincial network of ICUs. The dashboard utilizes the exiting hospital data sources and infrastructure to provide a timely snapshot of bed utilization as well as a historical view of unit occupancy and enables simulation scenarios for capacity planning in a dispersed geographical location. This information is used by administration for managing the scarce ICU resources and helping with standardization of admit and discharge processes to and from intensive care units in order to enhance efficiency. In our case, the existing hospital information systems proved to contain reliable data and the existing information technology infrastructure owned proper resources to be accessed to develop such valuable tool. Such dashboard presents necessary information to facilitate understanding of capacity and bed utilization and can help create a sense of community and standardization of critical care services which would eventually contribute to a more equitable and efficient health system.

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On the Benefit of Intensive Care for Very Old Patients

Boumendil¹

2011

Arch Intern Med

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Rationing critical care beds: A systematic review*

Cited by 252 publications

References 34 publications

The Ethics and Reality of Rationing in Medicine

The Ethics and Reality of Rationing in Medicine

An on-line dashboard to facilitate monitoring of provincial ICU bed occupancy in Alberta, Canada

On the Benefit of Intensive Care for Very Old Patients

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