How decisions are made to admit patients to medical intensive care units (MICUs): a survey of MICU directors at academic medical centers across the United States.
OBJECTIVE
To determine how medical intensive care unit (MICU) admission decisions are made at U.S. academic MICUs and to learn how these practices compare with the recommendations of the Society of Critical Care Medicine and the American Thoracic Society.


METHODS
A 22-question Web-based survey.


METHODS
University health sciences centers.


METHODS
MICU directors at academic U.S. medical centers offering fellowship programs in pulmonary/critical care or critical care medicine.


METHODS
The survey was sent by E-mail to 146 academic MICU directors.


RESULTS
Survey response rate was 83% (121/146). MICU attendings were the primary decision-maker for patient admission to the intensive care unit (ICU) in 40% of the MICUs during daytime hours, in 36% on weekends, and in 27% overnight. Critical care fellows and resident house staff were often responsible for making MICU admission decisions, particularly overnight and on weekends. Of the MICUs surveyed, 88% had written admission guidelines, although only 25% used them on a regular basis. Written restriction guidelines were present in only 21% of these ICUs, although 53% of MICU directors believed that MICUs should have standardized criteria for restricting admission to the ICU. Finally, 29% of MICUs surveyed did not authorize MICU attendings to deny ICU admission on a case-by-case basis for futile or inadvisable care, thereby maintaining an open door policy for ICU admission.


CONCLUSIONS
Significant practice variability exists across U.S. academic MICUs regarding how decisions are made to admit patients to the ICU. The majority of academic MICUs in the United States do not strictly employ ICU admission and restriction guidelines, as recommended by the Society of Critical Care Medicine and the American Thoracic Society.
Walter
Kristin L
KL
Medical Intensive Care Unit, Division of Pulmonary/Critical Care Medicine, Department of Internal Medicine, St. Joseph Hospital, Chicago, IL, USA. Kristin.Walter@Reshealthcare.org
Siegler
Mark
M
Hall
Jesse B
JB
D000046:Academic Medical Centers; D003657:Decision Making; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D010343:Patient Admission; D008486:Physician Executives / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D014481:United States