View Abstract

A6845 - Non-Critically Ill Patients in a Tertiary Care MICU: A Quantitative and Qualitative Analysis
Author Block: J. M. Aliotta, K. Dix, J. Ferguson, A. Edwards, N. S. Ward; Medicine, Rhode Island Hospital, Providence, RI, United States.
Rationale: Several recent large database studies have suggested that US ICUs are populated by a large fraction of patients who are not critically ill by common definition. These studies suffered from the fact that determinations were made using large database information and may not accurately characterize critically ill patients not on active life support. We sought to determine what percentage of our ICU admissions met a more broad definition of critically ill and to further characterize this group’s diagnoses and outcomes by using a detailed analysis of admissions. Methods: This study was conducted in the Rhode Island Hospital medical ICU, a 720 bed, tertiary care urban academic ICU. We conducted a detailed chart review of all admissions for four separate months from different times of the year. Our definition of critically ill patients was predicated on the presence of a diagnosis or therapy that would usually involve the care of an intensivist. Patients were classified as “critically ill” (CI) for any of three criteria: 1. On life support at admission, 2. Likely to need (>50% chance) life support in 12-24 hours, 3. Severe diagnosis (status epilepticus, septic shock, sub-massive pulmonary embolism, severe electrolyte disturbance, upper airway obstruction or massive blood transfusion). All other patients were deemed “non-critically ill” (NCI). Results: We reviewed 452 admissions from four months in 2016. Our data showed that 80.1% of patients met our criteria for CI, 9.5% were NCI, and 10.4% were indeterminate. Of CI patients, 81.8% were on life support at admission, 6.4% had imminent need of life support, and 45.3% had a severe diagnosis. The most common NCI diagnoses were drug overdose, alcohol withdrawal, and acute blood loss anemia. None of the NCI patients died in hospital or needed life support during their stay. Conclusions: In this tertiary care MICU only a small fraction were not critically ill at admission. Published high rates of non-critically ill patients in US ICUs may represent either patients who stay on after critical illness or an over representation of smaller ICUs with low acuity patients. Ten to 20% of our patients probably do not need an ICU admission, however, and may be better served on services that can provide higher levels of physician and nurse contact without an intensivist.