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Triage for surgical ICU: Anesthesiologist and intensivist as gatekeepers to ICU

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Author(s): Shanker J | Ghorpode A | Upasani C

Journal: Indian Journal of Critical Care Medicine
ISSN 0972-5229

Volume: 10;
Issue: 3;
Start page: 167;
Date: 2006;
Original page

Keywords: Post operative ICU care | surgical ICU | triage

ABSTRACT
Background: The demand for critical care beds among the medical services has already exceeded its supply. Thus allocating intensive care unit (ICU) beds to emergency cases is even more difficult task after doing triage for high risk scheduled elective cases as they fulfill the threshold for post operative intensive care. Materials and Methods: Retrospective observational study was done at Level-3 surgical ICU at tertiary referral hospital. Patients requiring mandatory postoperative ventilatory support and/ or ionotropic support who needed continuous haemodynamic monitoring were included in study. They were studied in two groups of elective and emergency cases against three headings of requisitions received for admissions, beds allotted for surgeries and patients admitted for postoperative intensive care. Intervention: One ICU bed was provided for emergency surgical case on daily basis. Other surgical admissions were triaged in three stages. Triage-1: It was done during preanaesthetic check-up and high risk patients were identified. Requisition forms in prescribed proforma were sent for level 2 triage, a day prior to surgery in all pre-booked elective cases. Triage-2: Urgency, refusals or appropriateness for admission was reassessed on prescribed proforma at second level triage by ICU in-charge. Triage-3: This was done for all operated patients in OT or recovery room by OT anaesthetist in consultation with operating surgical team. Result: Beds were allotted for 85.4% of emergency cases as against 74.7% of elective cases of total requisitions received for admissions. Out of these, 11.4% of emergency cases didn′t meet the criteria for postoperative ICU care as against 51.2% of elective cases even when the beds were confirmed preoperatively. We admitted 124 cases over 6 months. Pearson′s Chi Square test was used as test of significance. Conclusion: Individual institutional triage policy was helpful in equitable, ethical and efficient use of ICU beds for emergency services.
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