title: ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research.
abstract: To update the Society of Critical Care Medicine's guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research.
  
  
  
  An appointed Task Force followed a standard, systematic, and evidence-based approach in reviewing the literature to develop these guidelines.
  
  
  
  The assessment of the evidence and recommendations was based on the principles of the Grading of Recommendations Assessment, Development and Evaluation system. The general subject was addressed in sections: admission criteria and benefits of different levels of care, triage, discharge timing and strategies, use of outreach programs to supplement ICU care, quality assurance/improvement and metrics, nonbeneficial treatment in the ICU, and rationing considerations. The literature searches yielded 2,404 articles published from January 1998 to October 2013 for review. Following the appraisal of the literature, discussion, and consensus, recommendations were written.
  
  
  
  Although these are administrative guidelines, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. A limited amount of high-quality evidence made it difficult to answer all the questions asked related to ICU admission, discharge, and triage. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission, discharge, and triage process as well as in resolving issues of nonbeneficial treatment and rationing. We need to further develop preventive strategies to reduce the burden of critical illness, educate our noncritical care colleagues about these interventions, and improve our outreach, developing early identification and intervention systems.
authors.affiliation: 1Division of Anesthesiology and Critical Care, Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX. 2Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL. 3Center for Clinical Research and Scholarship, Rush University Medical Center, Rush University College of Nursing, Chicago, IL. 4Penn State Hershey Medical Center, Hershey, PA. 5Pocono Health System, East Stroudsburg, PA. 6College of Nursing, The Pennsylvania State University College of Nursing, Hershey, PA. 7Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX. 8PH Huntersville, Nursing Education, Practice and Research, Novant Health Huntersville Medical Center, Huntersville, NC. 9Department of Surgery, UNC-Chapel Hill, Carolinas Medical Center, Charlotte, NC. 10Department of Emergency Medicine, Durham VA Medical Center, Durham, NC. 11General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Nates
authors.forename: Mark
authors.initials: M
authors.lastname: Nunnally
authors.forename: Ruth
authors.initials: R
authors.lastname: Kleinpell
authors.forename: Sandralee
authors.initials: S
authors.lastname: Blosser
authors.forename: Jonathan
authors.initials: J
authors.lastname: Goldner
authors.forename: Barbara
authors.initials: B
authors.lastname: Birriel
authors.forename: Clara S
authors.initials: CS
authors.lastname: Fowler
authors.forename: Diane
authors.initials: D
authors.lastname: Byrum
authors.forename: William Scherer
authors.initials: WS
authors.lastname: Miles
authors.forename: Heatherlee
authors.initials: H
authors.lastname: Bailey
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
mesh_terms: D055317:Evidence-Based Practice; D015276:Health Care Rationing / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D000069342:Medical Overuse; D016134:Organizational Policy; D010343:Patient Admission / Q000592:standards*; D010351:Patient Discharge / Q000592:standards*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000592:standards; D014218:Triage / Q000592:standards*