• Ismaël Mohammedi, Olivier Martin, Laurent Argaud, Marc St Denis, Tristan Ferry, and Dominique Robert.
• Réanimation médicale, Hôpital Edouard Herriot, Lyon. ismael.mohammedi@chu-lyon.fr
• Presse Med. 2003 Nov 22;32(37 Pt 1):1738-40.

ObjectivesTo determine the reasons for refusing admission to an intensive care unit and the immediate outcome of the patients refused.MethodAll patients triaged for admission to a medical intensive care unit ICU during a three-month period were studied prospectively. The frequency and reason for refused admission were studied. The immediate outcome of the refused patients, together with the time lapse before their subsequent management were determined.ResultsOut of 251 patients, 132 (53%) were refused admission. Primary reasons for refusal was lack of beds (92%). Nearly one patient out of 5 was not subsequently treated in an intensive care unit.ConclusionSome refusals could have been avoided if the downstream networks (short-hospitalisation, re-habilitation centres.) had been able to accommodate the patients proposed. Moreover, by abandoning the strategy of wide admission to intensive care to the benefit of a selective triage of the patients proposed, a certain number of refusals would probably have been avoided. Nevertheless, there are obvious difficulties in the application of the latter method.

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