Refusal of Intensive Care Unit Admission Due to a Full Unit

Abstract

Delayed ICU admission due to a full unit at first referral is associated with increased mortality.

“Deterioration to Door Time”: An Exploratory Analysis of Delays in Escalation of Care for Hospitalized Patients

“…17 We postulate that there are likely systemrelated and patient-related factors that influence this relationship and contribute to what has come to be known as Bfailure to rescue.^1 8,19 System-related factors may include general inpatient floor staffing models and provider-patient ratios, 20 temporal issues including the time of day and day of the week at which deterioration occurs, 21 adherence to vital sign monitoring protocols, 22 and ICU bed availability. 7,23,24 There are also cultural barriers preventing staff from calling for assistance, [25][26][27][28] and nurse/physician providers often do not accurately self-assess the quality of their care for clinically deteriorating patients. 28 Patient factors, such as severity of illness, age, 29 medical comorbidities, and the number and type of specific criteria heralding deterioration 12,13,30 may all play a role as well.…”

Impossible decision? An investigation of risk trade-offs in the intensive care unit

“…This is where all beds in an ICU are occupied with critically ill patients, and the unit is asked to admit a suitable new patient. This means that a current patient has to be discharged before they are ready (Robert et al 2012), or out of daytime hours when ward areas are not optimally set up to accept a precarious discharge. Discharging a patient 48 h before they are ready increases the chance of postdischarge mortality by up to 39%, with discharges at night and investing (Glac 2009;Smith 2014), the importance (e.g.…”

A dynamic benchmarking system for assessing the recovery of inpatients: Evidence from the neurorehabilitation process

“…For instance, in 2008, a pregnant Japanese woman died after being refused by eight hospitals because none of them had a vacant bed (Coco Masters, 2009). Furthermore, research conducted by Robert, Reignier, and Tournoux (2012) showed that patients whose admissions to the Intensive Care Unit (ICU) were delayed due to the lack of vacancy were subject to a much higher risk of mortality.…”