'The MICU Is Full': One Hospital's Experience with an Overflow Triage Policy

摘要

The demand for critical care beds often outstrips their availability. As a result, patients with acute critical illness frequently experience delays in initial admission or transfer to critical care units and may suffer from potentially preventable morbidity and mortality.~1 Hospitals employ various strategies to speed the delivery of critical care to patients, including the use of (1) evidence-based triage and discharge policies to ensure appropriate utilization of medical ICU (MICU) bed resources and (2) mobile, hospitalwide critical care consultation services.~23 During times of MICU bed nonavailability, Jacobi Medical Center (Bronx, New York) activates a policy whereby critically ill medical patients with a primarily noncardiac diagnosis can be admitted to any available coronary care unit (CCU) bed. Although the CCU is not primarily staffed by critical care-certified physicians, it is able to provide patients with experienced critical care-trained nursing services in addition to medical technology that is found in the MICU setting. In this article, we describe our experience with this practice.