title: Unsuitable for the intensive care unit: what happens next?
abstract: BACKGROUND
  In recent years numbers of referrals to intensive care units (ICU) throughout the United Kingdom has been increasing. A number of referrals to the ICU are considered to be inappropriate for a variety of reasons, including those patients who are felt to be either too well for admission, or have comorbidities making survival unlikely and aggressive interventions unsuitable.
  
  
  OBJECTIVE
  This study aims to examine the outcomes and symptoms in those patients who are unsuitable for admission to ICU. By looking at this population we hope to ascertain if this is an at-risk group in terms of symptomatic or care needs at the end of life.
  
  
  METHODS
  This was as an observational prospective study with the sample population identified via the ICU referrals process. All patients referred to the ICU for admission but deemed unsuitable were recorded and followed up by researchers on the wards.
  
  
  RESULTS
  Fifty patients were identified between January and April 2009. Outcomes at one week were split between "death" (34%), "discharge" (24%), and ongoing illness/rehabilitation (40%). Levels of comorbidity were high, with a corresponding prevalence of severe breathlessness in all outcome groups.
  
  
  CONCLUSIONS
  The results suggest there are small numbers of patients with uncontrolled symptoms who could benefit from specialist input from the palliative care team. The identification of the imminently dying should facilitate appropriate communication of this by clinical staff and allow the relevant social, psychological, and spiritual preparations for death that are the hallmark of good care of the dying.
authors.affiliation: Department of Palliative Medicine, Glasgow Royal Infirmary, Glasgow, United Kingdom. medichi@doctors.org.uk
authors.forename: Alistair
authors.initials: A
authors.lastname: McKeown
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Booth
authors.forename: Laura
authors.initials: L
authors.lastname: Strachan
authors.forename: Alyson
authors.initials: A
authors.lastname: Calder
authors.forename: Paul W
authors.initials: PW
authors.lastname: Keeley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation; D055815:Young Adult