Use of intensive care unit priority model in directing intensive care unit admission in Sudan

Abstract

Background: The shortage of specialized intensive care beds is one of the principal factors that limit intensive care unit (ICU) admissions. This study explores the utilization of priority criteria in directing ICU admission and predicting outcomes. Methods: This was a prospective cross-sectional study conducted in two ICUs in Sudan from April to December 2018. Patients were assessed for ICU admission and were ranked by priority into Groups 1, 2, 3, and 4 (1 highest priority and 4 lowest priority), and these groups were compared using independent t -test, Chi-square, and ANOVA. Results: A total of 180 ICU admitted patients were enrolled, 53% were male. The prioritization categories showed that 86 (47.8%), 50 (27.8%), 13 (7.2%), and 31 (17.2%) were categorized as priority 1, 2, 3, and 4, respectively. Patients in priority groups 3 and 4had significantly higher ICU mortality rates compared to those in groups 1 and 2 ( P < 0.001), were likely to be older ( P < 0.001), had significantly more comorbidities ( P = 0.001), were more likely to be dependent ( P < 0.001), and had longer ICU length of stay ( P = 0.028). Conclusion: Patients classified as priority 3 and 4 were predominantly older and had many comorbidities. They were likely to be dependent, stay longer in ICU, and exhibit mortality.

Mortality rate, patient length of stay and medical cost prediction in different priority levels for patient admission to an intensive care unit

“…Similarly, Caldeira et al and Abdalrahman et al declared that patients in priority categories of D and C had higher MR and longer ICU stay compared to groups A and B ( P < 0.05). They explained that the coexistence of several comorbidities among admitted patients in two mentioned categories in addition to having physical limitations or disabilities were also among key factors which were associated with substantially increases both hospital LOS and ICU mortality (Abdalrahman et al , 2021; Caldeira et al , 2013). Thus, appropriate use of ICU resources is of necessary significance due to inadequacy of beds worldwide.…”

“…On the contrary, the Multiple Organ Dysfunction Score evaluates organ dysfunction in patients continuously and is mentioned as an instrument for routine assessment of patient progress (Caldeira et al, 2013). In a prospective, cross-sectional study by Abdalrahman et al (2021), two main factors including age and comorbidity were mentioned as priority factors to allocate ICU beds. They found that older age and having many comorbidities were likely to be associated with priority 3 and 4, as related patients were more dependent, having longer stays in ICU and exhibiting higher MRs (Abdalrahman et al, 2021).…”

“…In a prospective, cross-sectional study by Abdalrahman et al (2021), two main factors including age and comorbidity were mentioned as priority factors to allocate ICU beds. They found that older age and having many comorbidities were likely to be associated with priority 3 and 4, as related patients were more dependent, having longer stays in ICU and exhibiting higher MRs (Abdalrahman et al, 2021). In a systematic review of factors considered important by clinicians, some interacting factors including disease severity; comorbidities; age, functional status, state-of-mind; perception of patients' quality of life; and bed availability were regarded in ICU triage decisions (Gopalan and Pershad, 2018).…”

“…In addition the LOS in ICU and imposed financial burden to the health system is much greater in the mentioned former groups. This hypothesis suggests that patients how are categorized in priority 1 and 2 benefit more from being admitted to the ICU (Abdalrahman et al , 2021). Thus, classifying patients for admission triage is an efficient way of using available resources.…”