Rationing of intensive care unit services. An everyday occurrence

Abstract

We investigated the extent to which bed availability affects decision making in an intensive care unit (ICU). For 1,151 ICU patients, we determined the number of empty ICU beds available at times of admission and discharge and the outcome for those patients. For a randomly chosen group we assessed severity of illness. Patients admitted during times of bed shortage were, on average, more severely ill than those admitted when many beds were unoccupied. Patients discharged under crowded conditions were sicker and had a shorter stay than patients discharged when more beds were available. The relative risk of discharge was inversely related to empty bed availability, illness severity, and age. Bed availability had no effect on rates of death in the ICU, death after discharge, or readmission to the ICU. We conclude that physicians can effectively ration intensive care beds on a regular basis by altering admission and discharge decision making.

KIE: A study was conducted in the intensive care unit (ICU) of the Harborview Medical Center, operated by the University of Washington, to determine how bed availability affects admission and discharge practices. During times of bed shortage patients admitted were more severely ill, had shorter stays, and were discharged while sicker than when more beds were available. Bed availability had no affect on ICU mortality or readmission rates. The study did not encompass data on the mortality and morbidity of patients who may have been denied admission to the ICU when beds were scarce. Nevertheless, the investigators conclude, physicians at Harborview effectively rationed ICU beds. They recommend that further studies should seek to identify additional hospital, physician, and patient factors that allow for an equitable rationing process.