Limiting ICU admission from emergency services and wards
Med Clin (Barc). 2021 Dec 10;157(11):524-529.
doi: 10.1016/j.medcli.2020.08.021.
Epub 2021 Jan 7.
[Article in
English,
Spanish]
Authors
Patricia Escudero-Acha
1
, Oihana Leizaola
2
, Noelia Lázaro
3
, Mónica Cordero
4
, Ana María Cossío
5
, Daniel Ballesteros
6
, Paula Recena
7
, Ana Isabel Tizón
8
, Manuel Palomo
9
, Maite Misis Del Campo
10
, Santiago Freita
11
, Jorge Duerto
12
, Naia Mas Bilbao
13
, Barbara Vidal
14
, Domingo González-Romero
15
, Francisco Diaz-Dominguez
16
, Jaume Revuelto
17
, Maria Luisa Blasco
18
, Monica Domezain
19
, M A de la Concepción Pavía-Pesquera
20
, Miriam Pérez Ruiz
21
, Angel Pobo
22
, Inés Gomez-Acebo
23
, Alejandro González-Castro
24
; Grupo de Trabajo ADENI
Affiliations
- 1 Hospital Universitario Marqués de Valdecilla, Santander, España.
- 2 Hospital Universitario Central de Asturias, Oviedo, España.
- 3 Hospital 12 de Octubre, Madrid, España.
- 4 Hospital Universitario de Álava, Vitoria-Gasteiz, España.
- 5 Hospital Universitario Virgen Macarena, Sevilla, España.
- 6 Hospital Puerta de Hierro, Madrid, España.
- 7 Hospital Universitario de Cabueñes, Gijón, España.
- 8 Complexo Hospitalario Universitario de Ourense, Ourense, España.
- 9 Hospital de Sagunto, Valencia, España.
- 10 Hospital Universitario Germans Trias i Pujol, Badalona, España.
- 11 Complexo Hospitalario Universitario Alvaro Cunqueiro, Vigo, España.
- 12 Hospital Clínico San Carlos, Madrid, España.
- 13 Hospital Galdakao-Usansolo, Galdakao, España.
- 14 Hospital Universitario de Castellón, Castelló de la Plana, España.
- 15 Complejo Universitario Insular Materno Infantil, Las Palmas, España.
- 16 Complejo Asistencial Universitario de León, León, España.
- 17 Hospital Universitario Puerta del Mar, Cádiz, España.
- 18 Hospital Clínico de Valencia, Valencia, España.
- 19 Hospital Universitario de Cruces, Bilbao, España.
- 20 Hospital San Pedro, Logroño, España.
- 21 Hospital de Jerez, Jerez, España.
- 22 Hospital Joan XXIII de Tarragona, Tarragona, España.
- 23 Departamento de Preventiva y Salud Publica, Facultad de Medicina, Universidad de Cantabria, Santander, España.
- 24 Hospital Universitario Marqués de Valdecilla, Santander, España. Electronic address: e409@humv.es.
Abstract
Introduction:
Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die.
Methods:
Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests.
Results:
The ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p=.0158), the presence of severe chronic disease (P=.0169) and futility of treatment (P=.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P=.0021).
Conclusions:
There are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility.
Keywords:
Emergencies; Intensive care unit; Limitación de los tratamientos de soporte vital; Limitation of life support treatments; Unidad de cuidados intensivos; Urgencias.
Copyright © 2020 Elsevier España, S.L.U. All rights reserved.
MeSH terms
-
Emergency Service, Hospital
-
Hospitalization
-
Humans
-
Intensive Care Units*
-
Patient Admission
-
Quality of Life*
-
Referral and Consultation