News & Commentary

Either Too Sick Or Not Sick Enough


Fifty percent of patients admitted to intensive care units (ICUs) are either too well or too sick to derive any benefit from the costly care they would get, according to a research letter in the Dec. 27, 2016, issue of JAMA Internal Medicine.

Researchers looked at records of the Harbor–UCLA Medical Center of 808 patients admitted to that facility’s ICU from July 1, 2015, to June 15, 2016.

They separated the patients into four groups based on their need for ICU care according to the Society for Critical Care Medicine (SCCM) guidelines.

  • Priority 1: Patients who are critically ill and who need the kind of care that cannot be provided outside an ICU.
  • Priority 2: Patients who need close monitoring, and possible immediate intervention but can receive such care outside the ICU.
  • Priority 3: Dying patients or patients not likely to have much of a chance for meaningful functional recovery.
  • Priority 4: Patients who don’t need to be in an ICU at all.

Of the 808 admissions, 46.9% were Priority 1, 23.4% were Priority 2, 20.9% were Priority 3, and 8.8% were Priority 4.

“Over 50% of patients admitted to the ICU had priority ranks suggesting that they were potentially either too well (Priority 2) or too sick (Priority 3) to benefit from ICU care or could have received equivalent care in non-ICU settings (Priority 4),” the researchers from Harbor–UCLA Medical Center stated in their letter. And almost two thirds of early ICU days were spent on patients in those categories.

The study included only one hospital, but researchers said that the use of priority rankings identified ways that Harbor–UCLA Medical Center could improve allocation of ICU resources.

On the other hand, they admitted that ICU care is a complex animal, and measuring its use should also factor in patient preference, just what sort of medical conditions a particular ICU is equipped to handle, and the availability of resources.

“As such, our study cannot fully differentiate between appropriate and inappropriate care,” the researchers said. “However, appropriateness of ICU care for patients previously in good health but with poor progress from acute illness is likely different than those whose expected benefit from ICU care is low from progressive irreversible medical comorbidities.”

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