Recommended
More Related Content
What's hot
What's hot (20)
Similar to ICU - Admission, Triage, Discharge
Similar to ICU - Admission, Triage, Discharge (20)
More from AnaMariaCrawfordMDMS
More from AnaMariaCrawfordMDMS (17)
Recently uploaded
Recently uploaded (20)
ICU - Admission, Triage, Discharge
- 1. ICU Admission, Discharge, and Triage Guidelines
- 2. Critical Care…. Intensive Care… • Critical Care time-sensitive • Critical Care involves care that prevents further patient deterioration • Critical Care can occur outside of an Intensive Care Unit • Rapid Response Teams often provide Critical Care outside the ICU setting
- 3. Admission to the ICU: Reasons and Referrals • Common reasons for admission to the ICU include: • Need for intensive monitoring and • Need for intensive nursing care and improved nurse to patient ratio • Support of organ systems or life-support modalities • Need for care by specially trained physician and nursing teams • Common locations referring patients to ICU: • Operating Room • Post-Anesthesia Care Unit (PACU) • Emergency Medicine Department • Medical or Surgical Ward • Other Healthcare Facilities
- 4. Admission to the ICU: Common Diagnoses Neurologic compromise Hemodynamic Support Acute Myocardial Ischemia/Infarction Renal/Metabolic Support Post-operative Monitoring GI Bleeding
- 5. Admission Recommendations Joseph L. Nates et al., “ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research,” Critical Care Medicine 44, no. 8 (August 2016): 1553–1602, https://doi.org/10.1097/CCM.0000000000001856.
- 6. Admission Recommendations Joseph L. Nates et al., “ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research,” Critical Care Medicine 44, no. 8 (August 2016): 1553–1602, https://doi.org/10.1097/CCM.0000000000001856.
- 7. Joseph L. Nates et al., “ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research,” Critical Care Medicine 44, no. 8 (August 2016): 1553–1602, https://doi.org/10.1097/CCM.0000000000001856. Triage Recommendations
- 8. Triage Recommendations Joseph L. Nates et al., “ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research,” Critical Care Medicine 44, no. 8 (August 2016): 1553–1602, https://doi.org/10.1097/CCM.0000000000001856.
- 9. Joseph L. Nates et al., “ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research,” Critical Care Medicine 44, no. 8 (August 2016): 1553–1602, https://doi.org/10.1097/CCM.0000000000001856. Discharge, Outreach, Quality Improvement Recommendations
Editor's Notes
- Questions often arise for providers when deciding how to triage patients, when to admit patients to the ICU, and when patients are stable enough to discharge from the ICU
- Critical care is time-sensitive patient care that can prevent deterioration to death or disability. Although often associated with an intensive care units, critical care can occur anywhere and often does. For example, an unstable patient on the hospital ward requiring a rapid response medical team, unstable patients in the ED, patients who decompensate in the OR or PACU, or even outside the hospitals when patients require CPR for sudden cardiac arrest.
- Admission criteria are not uniform across institutions. Each institution must develop ICU admission guidelines based upon their facilities resources. Improved outcomes must be balanced with resource utilization and bed availability. This Table summarizes evidence-based recommendations and best practices from an article published in 2016 in the journal Critical Care Medicine.
- The recommendations consider factors of admission such as the need for life-sustaining interventions, the probability of meaningful recovery, diagnosis, specialized services available, specialized physician and nursing team availability, and prognosis for regaining quality of life.
- The same guidelines offer triage considerations. They recommend that triage guidelines and policies be made explicit and disclosed in advance. Triage considerations must not discriminate based on age, gender, race, ethnicity, or social or financial status. They state that over-triage is preferable to under-triage and that transfer should occur quickly. Close monitoring is recommended through the process of triage and transport to the ICU. Further recommendations include preparedness for mass casualty, emergency response and mass illness.
- Triage of cancer patients should be based upon prognosis. Use of scoring systems to determine level of care is discouraged as they are inaccurate at predicting individual mortality. During epidemics, it is recommended that non-traditional locations be considered for care of critically ill patients. Disaster plans should be in place and should coordinate with the entire healthcare system.
- Each institution should develop its own discharge criteria and should be made available in its policy documents. Time for discharge is based upon the patients’ physiologic parameters and lack of need for further ICU level care. Scoring systems are discourage due to individual inaccuracy. Written and verbal communication are key during discharge sign out to the accepting team and can decrease readmission to the ICU. It is recommended that intensive care units develop rapid response care teams and outreach programs to review early patients that are acutely ill but not located in the intensive care unit. Finally, it is recommended that ICUs institute quality assurance and improvement programs.