title: Medical intensive care unit consults occurring within 48 hours of admission: a prospective study.
abstract: BACKGROUND
  Critical care consults requested shortly after admission could represent a triage error. This consult process has not been adequately assessed, and data are retrospective relying on discharge diagnoses.
  
  
  OBJECTIVE
  The aims of this study were to identify reasons for medical Intensive care unit (MICU) consultations within 48 hours of admission and to detect differences between those accepted and those denied MICU admission.
  
  
  METHODS
  Data were prospectively collected including demographics, reason for consultation, Acute Physiology and Chronic Health Evaluation II score, Elixhauser comorbidity measure, functional status, need for assisted ventilation or vasopressor, presence of do-not-resuscitate (DNR) order, and whether a DNR order was obtained after MICU consultation.
  
  
  RESULTS
  Ninety-four percent of patients consulted were not initially evaluated in the emergency department, half of whom were accepted. Respiratory failure, sepsis, and alcohol withdrawal were the most frequent reasons for MICU transfers. Factors predicting MICU admission included respiratory illness, better baseline functional status, and less comorbidity, whereas DNR predicted rejection. We did not find differences in hospital mortality; but hospital length of stay was longer.
  
  
  CONCLUSIONS
  Prospective examination of the consult process suggests that disease progression rather than triage error accounted for most unplanned transfers. Functional status and comorbidity predicted MICU admission rather than illness severity. Goals of care were not being discussed adequately. We did not detect differences in mortality although hospital length of stay was increased.
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, The Long Island Jewish Medical Center, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY. Electronic address: rocohen@nshs.edu.
authors.forename: Rubin I
authors.initials: RI
authors.lastname: Cohen
authors.affiliation: Krasnoff Quality Management Institute, The North Shore-LIJ Health System, Manhasset, NY.
authors.forename: Ann
authors.initials: A
authors.lastname: Eichorn
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, The Long Island Jewish Medical Center, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Caroline
authors.initials: C
authors.lastname: Motschwiller
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, The Long Island Jewish Medical Center, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Viera
authors.initials: V
authors.lastname: Laktikova
authors.affiliation: Department of Medicine, The Long Island Jewish Medical Center, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Grace
authors.initials: G
authors.lastname: La Torre
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, The Long Island Jewish Medical Center, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ginsberg
authors.affiliation: Division of Pulmonary, Sleep and Critical Care Medicine, The Long Island Jewish Medical Center, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Harry
authors.initials: H
authors.lastname: Steinberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000458:organization & administration; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration*; D012121:Respiration, Artificial; D014218:Triage
keywords: Elixhauser; Functional status; ICD-9; MICU; Unplanned transfers