TY  - JOUR
T1  - INtensive care unit admitting patterns in the veterans affairs health care system
AU  - Chen LM, Render M, Sales A, Kennedy EH, Wiitala W, Hofer TP
Y1  - 2012/09/10
N1  - 10.1001/archinternmed.2012.2606
JO  - Archives of Internal Medicine
SP  - 1220
EP  - 1226
VL  - 172
IS  - 16
N2  - Background 
                  Critical care resource use accounts for almost 1% of US gross domestic product and varies widely among hospitals. However, we know little about the initial decision to admit a patient to the intensive care unit (ICU).Methods 
                  To describe hospital ICU admitting patterns for medical patients after accounting for severity of illness on admission, we performed a retrospective cohort study of the first nonsurgical admission of 289 310 patients admitted from the emergency department or the outpatient clinic to 118 Veterans Affairs acute care hospitals between July 1, 2009, and June 30, 2010. Severity (30-day predicted mortality rate) was measured using a modified Veterans Affairs ICU score based on laboratory data and comorbidities around admission. The main outcome measure was direct admission to an ICU.Results 
                  Of the 31 555 patients (10.9%) directly admitted to the ICU, 53.2% had 30-day predicted mortality at admission of 2% or less. The rate of ICU admission for this low-risk group varied from 1.2% to 38.9%. For high-risk patients (predicted mortality >30%), ICU admission rates also varied widely. For a 1-SD increase in predicted mortality, the adjusted odds of ICU admission varied substantially across hospitals (odds ratio = 0.85-2.22). As a result, 66.1% of hospitals were in different quartiles of ICU use for low- vs high-risk patients (weighted κ = 0.50).Conclusions 
                  The proportion of low- and high-risk patients admitted to the ICU, variation in ICU admitting patterns among hospitals, and the sensitivity of hospital rankings to patient risk all likely reflect a lack of consensus about which patients most benefit from ICU admission.
SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2012.2606
UR  - http://dx.doi.org/10.1001/archinternmed.2012.2606
ER  -