Refusal of beds and triage of patients admitted to intensive care units in Brazil: a cross-sectional national survey

Objective To obtain data on bed refusal in intensive care units in Brazil and to evaluate the use of triage systems by professionals. Methods A cross-sectional survey. Using the Delphi methodology, a questionnaire was created contemplating the objectives of the study. Physicians and nurses enrolled in the research network of the Associação de Medicina Intensiva Brasileira (AMIBnet) were invited to participate. A web platform (SurveyMonkey®) was used to distribute the questionnaire. The variables in this study were measured in categories and expressed as proportions. The chi-square test or Fisher’s exact test was used to verify associations. The significance level was set at 5%. Results In total, 231 professionals answered the questionnaire, representing all regions of the country. The national intensive care units had an occupancy rate of more than 90% always or frequently for 90.8% of the participants. Among the participants, 84.4% had already refused admitting patients to the intensive care unit due to the capacity of the unit. Half of the Brazilian institutions (49.7%) did not have triage protocols for admission to intensive beds. Conclusions Bed refusal due to high occupancy rates is common in Brazilian intensive care units. Even so, half of the services in Brazil do not adopt protocols for triage of beds.

[1]  Sandra Levien,et al.  COVID-19 no Brasil , 2021 .

[2]  G. Escobar,et al.  Goldilocks, the Three Bears and Intensive Care Unit Utilization: Delivering Enough Intensive Care But Not Too Much. A Narrative Review , 2020, Pulmonary Therapy.

[3]  Joana Brás Varanda Marques,et al.  Método DELPHI: caracterização e potencialidades na pesquisa em Educação , 2018, Pro-Posições.

[4]  M. Mazumdar,et al.  Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients* , 2018, Critical care medicine.

[5]  P. Ziegelmann,et al.  Point-of-care ultrasonography in Brazilian intensive care units: a national survey , 2018, Annals of Intensive Care.

[6]  I. Chouchène,et al.  Determinants and outcomes associated with decisions to deny intensive care unit admission in Tunisian ICU , 2018, The Pan African medical journal.

[7]  C. Sprung,et al.  Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine. , 2016, Journal of critical care.

[8]  Carri W. Chan,et al.  Association Among ICU Congestion, ICU Admission Decision, and Patient Outcomes* , 2016, Critical care medicine.

[9]  Mark Nunnally,et al.  ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research , 2016, Critical care medicine.

[10]  H. Wollersheim,et al.  Rationing in the intensive care unit in case of full bed occupancy: a survey among intensive care unit physicians , 2015, BMC Anesthesiology.

[11]  J. Orsini,et al.  Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage , 2014, Journal of clinical medicine research.

[12]  Matteo Bottai,et al.  ICU Admittance by a Rapid Response Team Versus Conventional Admittance, Characteristics, and Outcome* , 2013, Critical care medicine.

[13]  Caroline Tournoux-Facon,et al.  Refusal of intensive care unit admission due to a full unit: impact on mortality. , 2012, American journal of respiratory and critical care medicine.

[14]  Amine Ali Zeggwagh,et al.  Determinants and outcomes associated with decisions to deny or to delay intensive care unit admission in Morocco , 2012, Intensive Care Medicine.

[15]  M. Levy,et al.  Rule of rescue or the good of the many? An analysis of physicians’ and nurses’ preferences for allocating ICU beds , 2011, Intensive Care Medicine.

[16]  C. Sprung,et al.  Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis , 2011, Critical care.

[17]  Tiemi Matsuo,et al.  Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study , 2011, Critical care.

[18]  P. Young,et al.  Intensive care triage in Australia and New Zealand. , 2010, The New Zealand medical journal.

[19]  Gary H. Mills,et al.  Reasons for refusal of admission to intensive care and impact on mortality , 2010, Intensive Care Medicine.

[20]  E. Rezende,et al.  Critérios para admissão de pacientes na unidade de terapia intensiva e mortalidade , 2010 .

[21]  M. Meade,et al.  A guide for the design and conduct of self-administered surveys of clinicians , 2008, Canadian Medical Association Journal.

[22]  Jesse B. Hall,et al.  How decisions are made to admit patients to medical intensive care units (MICUs): A survey of MICU directors at academic medical centers across the United States , 2008, Critical care medicine.

[23]  Márcio Soares,et al.  Pacientes Clínicos Referenciados, mas não Internados na Unidade de Terapia Intensiva: Prevalência, Características Clínicas e Prognóstico* Referred Medical Patients not admitted to the Intensive Care Unit: Prevalence, Clinical Characteristics and Prognosis. , 2006 .

[24]  Gavin Joynt,et al.  Prospective evaluation of patients refused admission to an intensive care unit: triage, futility and outcome , 2001, Intensive Care Medicine.

[25]  C. Sprung,et al.  Evaluation of triage decisions for intensive care admission. , 1999, Critical care medicine.

[26]  Klim McPherson,et al.  Mortality among appropriately referred patients refused admission to intensive-care units , 1997, The Lancet.

[27]  Fernando Porto,et al.  Custos das diárias de unidade de terapia intensiva no Sistema Único de Saúde na COVID-19 , 2022, JMPHC | Journal of Management & Primary Health Care | ISSN 2179-6750.