• Journal of critical care · Jun 2019

    A decision-aid tool for ICU admission triage is associated with a reduction in potentially inappropriate intensive care unit admissions.

    • Ramos Joao Gabriel Rosa JGR Medical Sciences PhD program, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil; Intensive Care Unit, Hospital Sao Raf, Otavio T Ranzani, Beatriz Perondi, Dias Roger Daglius RD Emergency Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil; Emergency Department, Brig, Daryl Jones, Carvalho Carlos Roberto Ribeiro CRR Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Pa, Irineu Tadeu Velasco, and Daniel Neves Forte.
    • Medical Sciences PhD program, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil; Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil. Electronic address: jgramos@usp.br.
    • J Crit Care. 2019 Jun 1; 51: 77-83.

    PurposeIntensive care unit (ICU) admission triage occurs frequently and often involves highly subjective decisions that may lead to potentially inappropriate ICU admissions. In this study, we evaluated the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions.MethodsThis was a prospective, before-after study. Urgent ICU referrals to ten ICUs in a tertiary hospital in Brazil were assessed before and after the implementation of the decision-aid tool. Our primary outcome was the proportion of potentially inappropriate ICU referrals (defined as priority 4B or 5 referrals, accordingly to the Society of Critical Care Medicine guidelines of 1999 and 2016, respectively) admitted to the ICU within 48 h. We conducted multivariate analyses to adjust for potential confounders and evaluated the interaction between phase and triage priority.ResultsOf the 2201 patients analyzed, 1184 (53.8%) patients were admitted to the ICU. After adjustment for confounders, implementation of the decision-aid tool was associated with a reduction in potentially inappropriate ICU admissions using either the 1999 [adjOR (95% CI) = 0.36 (0.13-0.97)] or 2016 [adjOR (95%CI) = 0.35 (0.13-0.96)] definitions.ConclusionImplementation of a decision-aid tool for ICU triage was associated with a reduction in potentially inappropriate ICU admissions.Copyright © 2019 Elsevier Inc. All rights reserved.

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