title: Influence of ICU-bed availability on ICU admission decisions.
abstract: BACKGROUND
  The potential influence of bed availability on triage to intensive care unit (ICU) admission is among the factors that may influence the ideal ratio of ICU beds to population: thus, high bed availability (HBA) may result in the admission of patients too well or too sick to benefit, whereas bed scarcity may result in refusal of patients likely to benefit from ICU admission.
  
  
  METHODS
  Characteristics and outcomes of patient admitted in four ICUs with usual HBA, defined by admission refusal rate less than 11 % because of bed unavailability, were compared to patients admitted in six ICUs with usual low bed availability (LBA), i.e., an admission refusal rate higher than 10 % during a 90-day period.
  
  
  RESULTS
  Over the 90 days, the mean number of days with no bed available was 30 ± 16 in HBA units versus 48 ± 21 in LBA units (p < 0.01). The proportion of admitted patients was significantly higher in the HBA (80.1 %; n = 659/823) than in the LBA units [61.6 %: n = 480/779; (p < 0.0001)]. The proportion of patients deemed too sick to benefit from admission was higher in LBA (9.0 %; n = 70) than in the HBA (6.3 %; n = 52) units (p < 0.05). The HBA group had a significantly greater proportion of patients younger than 40 years of age (22.5 %; n = 148 versus 14 %; n = 67 in LBA group; p < 0.001) and higher proportions of patients with either high or low simplified acute physiologic score II values.
  
  
  CONCLUSIONS
  Bed availability affected triage decisions. Units with HBA trend to admit patients too sick or too well to benefit.
authors.affiliation: Réanimation Médicale, Université de Poitiers, CHU Poitiers, Inserm Unit CIC 1402; Groupe ALIVE, Poitiers, France. rene.robert@chu-poitiers.fr.
authors.forename: René
authors.initials: R
authors.lastname: Robert
authors.affiliation: Réanimation Médicale, Université de Poitiers, CHU Poitiers, Inserm Unit CIC 1402; Groupe ALIVE, Poitiers, France. r.coudroy@chu-poitiers.fr.
authors.forename: Rémi
authors.initials: R
authors.lastname: Coudroy
authors.affiliation: Réanimation Médicale, Université de Poitiers, CHU Poitiers, Inserm Unit CIC 1402; Groupe ALIVE, Poitiers, France. Stephanie.ragot@chu-poitiers.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Ragot
authors.affiliation: Réanimation Polyvalente, Centre Hospitalier La Rochelle, La Rochelle, France. olivier.lesieur@ch-larochelle.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lesieur
authors.affiliation: Medical-Surgical Intensive Care Unit, Hospital Center, 45067, Orleans, France. isabelle.runge@ch-orleans.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runge
authors.affiliation: Réanimation Médicale, Université D'Angers, CHU Angers, Angers, France. visouday@chu-angers.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Souday
authors.affiliation: Réanimation Polyvalente, Centre Hospitalier Angoulême, Angouleme, France. arnaud.desachy@ch-angouleme.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Desachy
authors.affiliation: Surgical Intensive Care, District Hospital, 35400, Saint-Malo, France. Jp.gouello@ch-stmalo.fr.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Gouello
authors.affiliation: Medical-Surgical Intensive Care, District Hospital, 36000, Chateauroux, France. michel.hira@chateauroux.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Hira
authors.affiliation: Medical-Surgical Intensive Care, District Hospital, 28018, Chartres, France. mhamrouni@ch-chartres.fr.
authors.forename: Mouldi
authors.initials: M
authors.lastname: Hamrouni
authors.affiliation: Medical Intensive Care, University of Nantes, CHU Nantes, Nantes, France. jean.reignier@chu-nantes.fr.
authors.forename: Jean
authors.initials: J
authors.lastname: Reignier
keywords: Admission; Bed occupancy; ICU; Refusal; Scarcity; Triage