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ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research
Joseph L. Nates, MD, MBA, FCCM (Chair); Mark Nunnally, MD, FCCM; Ruth Kleinpell, PhD, RN, FAAN, FCCM; Sandralee Blosser, MD, FCCP, FCCM; Jonathan Goldner, DO, FCCP, FCCM; Barbara Birriel, MSN, CRNP, ACNP-BC, FCCM; Clara S. Fowler, MS; Diane Byrum, RN, MSN, CCRN, CCNS, FCCM; William Scherer Miles, MD, FACS, FCCM; Heatherlee Bailey, MD, FAAEM, FCCM; Charles L. Sprung, MD, JD, MCCM
the Society of Critical Care Medicine
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Critical Care Physicians, General Medical Professionals, Nurses and/or Other Critical Care Medical Professionals
Objectives: To update the Society of Critical Care Medicine’s guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research.
Design: An appointed Task Force followed a standard, systematic, and evidence-based approach in reviewing the literature to develop these guidelines.
Measurements and Main Results: The assessment of the evidence and recommendations was based on the principles of the Grading of Recommendations Assessment, Development and Evaluation system. The general subject was addressed in sections: admission criteria and benefits of different levels of care, triage, discharge timing and strategies, use of outreach programs to supplement ICU care, quality assurance/improvement and metrics, non beneficial treatment in the ICU, and rationing considerations. The literature searches yielded 2,404 articles published from January 1998 to October 2013 for review. Following the appraisal of the literature, discussion, and consensus, recommendations were written.
Conclusion: Although these are administrative guidelines, the subjects addressed encompass complex ethical and medico-legal aspects of patient care that affect daily clinical practice. A limited amount of high-quality evidence made it difficult to answer all the questions asked related to ICU admission, discharge, and triage. Despite these limitations, the members of the Task Force believe that these recommendations provide a comprehensive framework to guide practitioners in making informed decisions during the admission, discharge, and triage process as well as in resolving issues of non beneficial treatment and rationing. We need to further develop preventive strategies to reduce the burden of critical illness, educate our noncritical care colleagues about these interventions, and improve our outreach, developing early identification and intervention systems.
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