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    Icu Adt

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    Leonardo Liswojo
    The document discusses guidelines for ICU admission, discharge, and triage. It notes that ICU care accounts for a significant portion of hospital costs, with higher costs for non-survivors. Appropriate utilization of limited ICU resources is important but complex. ICU admission criteria include potential or established organ failure and factors like diagnosis, severity of illness, age, and prognosis. Triage aims to place patients at the appropriate level of care based on need and likelihood of benefiting from ICU treatment, as demand often exceeds supply requiring rationing. Patients should generally be admitted if they require specialized ICU competencies, are clinically unstable, or at high risk of decline.

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    Icu Adt

    Uploaded by

    Leonardo Liswojo
    34 views18 pages
    The document discusses guidelines for ICU admission, discharge, and triage. It notes that ICU care accounts for a significant portion of hospital costs, with higher costs for non-survivors. Appropriate utilization of limited ICU resources is important but complex. ICU admission criteria include potential or established organ failure and factors like diagnosis, severity of illness, age, and prognosis. Triage aims to place patients at the appropriate level of care based on need and likelihood of benefiting from ICU treatment, as demand often exceeds supply requiring rationing. Patients should generally be admitted if they require specialized ICU competencies, are clinically unstable, or at high risk of decline.

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    ICU ADT

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    The document discusses guidelines for ICU admission, discharge, and triage. It notes that ICU care accounts for a significant portion of hospital costs, with higher costs for non-survivors. Appropriate utilization of limited ICU resources is important but complex. ICU admission criteria include potential or established organ failure and factors like diagnosis, severity of illness, age, and prognosis. Triage aims to place patients at the appropriate level of care based on need and likelihood of benefiting from ICU treatment, as demand often exceeds supply requiring rationing. Patients should generally be admitted if they require specialized ICU competencies, are clinically unstable, or at high risk of decline.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views18 pages

    Icu Adt

    Uploaded by

    Leonardo Liswojo
    The document discusses guidelines for ICU admission, discharge, and triage. It notes that ICU care accounts for a significant portion of hospital costs, with higher costs for non-survivors. Appropriate utilization of limited ICU resources is important but complex. ICU admission criteria include potential or established organ failure and factors like diagnosis, severity of illness, age, and prognosis. Triage aims to place patients at the appropriate level of care based on need and likelihood of benefiting from ICU treatment, as demand often exceeds supply requiring rationing. Patients should generally be admitted if they require specialized ICU competencies, are clinically unstable, or at high risk of decline.

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    © All Rights Reserved
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    of 18

    ICU Admission,

    Discharge &
    Triage
    Guidelines
    The “Expensive” Care Unit

    • USA :*)
    - 20-28% of total inpatient costs
    - 16-38,4% of hospital costs
    • 1 ICU day = 3 to 6 times non-ICU day
    • Higher cost in non-survivors
    • ICU resources are finite

    The appropriate utilization of ICU beds is essential, but it is


    complex and a challenge to attain

    *)Coopersmith CM, et al : A comparasion of critical are research funding and the financial burden of crtical illnes in the United
    States. Crit Care Med 2012
    ICU Admission
    Criteria

    A service for patients with


    potentially recoverable conditions
    who can benefit from more
    detailed observation and invasive
    treatment than can be safely
    provided in general wards or high
    dependency areas.
    ICU Triage
    ● Triage is the process of placing
    patients at their most appropriate level
    of care, based upon their need for
    medical treatment and the assessment
    that they will benefit from ICU care.

    ● demand for ICU services exceeds


    supply

    ● rationing of ICU beds is common


    01.
    ICU
    Admission
    ICU Admission Criteria
    • Potential or established organ failure
    • Factors to be considered
    ü Diagnosis
    ü Severity of illness
    ü Age and functional status
    ü Co-existing disease
    ü Prognosis
    ü Availability of suitable treatment
    ü Response to treatment to date
    ü Recent cardiopulmonary arrest
    ü Anticipated quality of life
    ü The patient’s wishes
    c

    c
    Care in the ICU Versus Intensive Care in the Wards
    Recommendations:
    • We suggest that patients with invasive mechanical ventilation or complex life-
    threatening conditions, including those with sepsis, be treated in an ICU. Patients
    should not be weaned from mechanical ventilation on the general ward unless the
    ward is a high-dependency/intermediate unit (grade 2C).

    • We suggest that critically ill patients in the ED or on the general ward be transferred
    to a higher level of care, such as the ICU, in an expeditious manner (grade 2D)
    • There is an increased risk of cardiac arrest for sicker ward patients when medical
    ICU beds are not available and increased risk of mortality and ICU length of stay
    (LOS) if there is a delay in admitting a critically ill patient from the hospital ward to
    the ICU
    • A delay of 4 hours or more in transferring patients from the hospital ward to the ICU
    was associated with a significant increase in mortality in a hospital.
    • Young et al found that patients who were rapidly transferred to the ICU after
    identification of a problem (rapid transfers) had a hospital mortality rate of 11%,
    whereas those who arrived in the ICU after 4 hours (slow transfers) had a hospital
    mortality rate of 41% (relative risk [RR], 3.5; 95% CI, 1.4–9.5; p = 0.004).

    Young MP, Gooder VJ, McBride K, et al: Inpatient transfers to the intensive care unit: Delays are associated with
    increased mortality and morbidity. J Gen Intern Med 2003
    02.
    ICU
    TRIAGE
    In general, patients admitted to the ICU should meet one or
    more of the following criteria:
    • Require care involving specialized competency of ICU staff that is not widely
    available elsewhere in the hospital (e.g., invasive mechanical ventilation,
    management of shock, extracorporeal membrane oxygenation, and intraaortic
    balloon pump).
    • Have clinical instability (e.g., status epilepticus, hypoxemia, and hypotension).
    • Be at high risk for imminent decline (e.g., impending intubation)
    c

    c
    c
    c

    c
    c

    c
    03.
    ICU
    Discharge
    THANK YOU

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