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May 1987

Utilization of Critical Care Units: A Prospective Study of Physician Triage and Patient Outcome

Author Affiliations

From the Clinical Epidemiology Unit, Division of General Internal Medicine, Department of Medicine, Cornell University, New York. Dr Sax is a fellow of the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md. Dr Charlson is a Henry J. Kaiser Family Foundation faculty scholar in general internal medicine.

Arch Intern Med. 1987;147(5):929-934. doi:10.1001/archinte.1987.00370050125021

• To identify patients likely to be admitted to a critical care unit as well as those at high risk of deterioration, we studied all patients admitted to the medical service. Cardiac patients had a high likelihood of unit admission even if they were rated as not ill and stable, whereas ill and unstable noncardiac patients went to the floor. Stable cardiac or noncardiac patients who were not severely ill had very low deterioration and mortality, but unstable, severely ill patients with cardiac or noncardiac reasons for admission had high deterioration rates. If the goal is to admit patients at highest risk, the optimal strategy is to admit unstable, severely ill, and moribund patients in both the cardiac and noncardiac groups. By doing this, it is possible to decrease unit admission of patients likely to do well, increase the admission of patients likely to do poorly, while decreasing the number of patients admitted.

(Arch Intern Med 1987;147:929-934)

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