ICU Admission, Discharge, and Triage Guidelines

We suggest that individual institutions and their ICU leaders develop policies to meet their specific population needs (e.g., trauma, burns, and neurological), taking into consideration their institutional limitations such as ICU size and therapeutic capabilities.

To optimize resource use while improving outcomes, we suggest guiding ICU admissions on the basis of a combination of:

We suggest using the following tools for bed allocation during the admission and triage processes:

We suggest patients needing life-sustaining interventions who have a higher probability of recovery and would accept cardiopulmonary resuscitation receive a higher priority for ICU admission than those with a significantly lower probability of recovery who choose not to receive cardiopulmonary resuscitation.

We suggest that patients with invasive mechanical ventilation or complex life-threatening conditions, including those with sepsis, be treated in an ICU. Patients should not be weaned from mechanical ventilation on the general ward unless the ward is a high-dependency/intermediate unit.

We suggest that critically ill patients in the emergency department or on the general ward be transferred to a higher level of care, such as the ICU, in an expeditious manner.

We suggest avoiding admitting to a specialized ICU patients with a primary diagnosis not associated with that specialty (i.e., boarding).

We suggest the admission of neurocritically ill patients to a neuro-ICU, especially those with a diagnosis of intracerebral hemorrhage or head injury.

We recommend a high-intensity ICU model, characterized by the intensivist being responsible for dayto- day management of the patient, either in a “closed ICU” setting (in which the intensivist serves as the primary physician) or through a hospital protocol for mandatory intensivist consultation.

We do not recommend a 24-hr/7-d intensivist model if the ICU has a high-intensity staffing model (vide supra) during the day or night.

We suggest optimizing ICU nursing resources and nursing ratios, taking into consideration available nursing resources (e.g., levels of education, support personnel, specific workloads), patients’ needs, and patients’ medical complexity.

Because of current constraints on the availability and cost of 24-hr intensivist coverage, further studies are needed to address the efficacy of coverage with critical care–trained advance practice providers, including nurse practitioners and physician assistants, and critical care telemedicine.

We suggest that patients receive ICU treatment if their prognosis for recovery and quality of life is acceptable regardless of their length of ICU stay. However, factors such as age, comorbidities, prognosis, underlying diagnosis, and treatment modalities that can influence survival should be taken into account.