Division of Pulmonary, Critical Care and Sleep Medicine, New Hyde Park, NY, USA.
Minerva Anestesiol. 2012 Nov;78(11):1226-33. Epub 2012 Jun 14.
Few data exist on Medical Intensive Care Unit (MICU) triage practices. We assessed MICU triage practices in our medical center.
We collected data on all MICU consultations for one year, including each patient's APACHE II score at time of consultation. We assessed functional impairment at baseline and at time of MICU consultation.
A total of 54% out of 572 consultations resulted in admission. Patients were less likely to be admitted if baseline functional status was poor (OR, 0.29; 95% CI 0.17-0.50), if a do-not-resuscitate order was present (OR, 0.44; 95% CI, 0.21-0.89), and if the MICU attending spent more than 25% of professional time in MICU (OR, 2.44; 95% CI, 1.37-4.32). Patients were more likely to be admitted if functional status at time of MICU consultation was poor (OR, 2.30; 95% CI 1.46-3.48). Patients' age, insurance, ethnicity, severity of illness, presence of malignancy, or whether patient's primary physician was on staff were not independently associated with MICU admission decisions. MICU attendings rarely cited functional status as reason for MICU refusal on the consult forms.
MICU admission decisions are implicitly based on patients' baseline functional status rather than severity of illness.
关于重症加强护理病房（MICU）分诊实践的数据很少。我们评估了我们医疗中心的 MICU 分诊实践。
我们收集了一年中所有 MICU 会诊的数据，包括每位患者会诊时的急性生理学与慢性健康状况评分 II（APACHE II）。我们评估了基线和 MICU 会诊时的功能障碍。
572 次会诊中有 54%导致住院。如果基线功能状态较差（OR，0.29；95%CI 0.17-0.50），如果存在不复苏医嘱（OR，0.44；95%CI，0.21-0.89），并且 MICU 主治医生在 MICU 中花费超过 25%的专业时间（OR，2.44；95%CI，1.37-4.32），患者入院的可能性较小。如果 MICU 会诊时的功能状态较差（OR，2.30；95%CI 1.46-3.48），患者入院的可能性较大。患者的年龄、保险、种族、疾病严重程度、恶性肿瘤的存在或患者的主治医生是否在医院工作与 MICU 入院决策无关。MICU 主治医生很少在会诊表上以功能状态为由拒绝 MICU 收治。
MICU 入院决策是基于患者的基线功能状态而不是疾病严重程度做出的。
