The use of risk predictions to identify candidates for intermediate care units: Implications for intensive care utilization and cost

Chest

Volumn 108, Issue 2, 1995, Pages 490-499

  Zimmerman, J E ^a   Wagner, D P ^a   Knaus, W A ^a   Williams, J F ^a   Kolakowski, D ^a   Draper, E A ^a  

^a GEORGE WASHINGTON UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

cost savings; critical care; facility design and construction; hospital bed capacity; intensive care; organizational policy; outcome assessment (health care); resource allocation; triage; utilization review

Indexed keywords

ARTICLE; COST CONTROL; HOSPITAL BED CAPACITY; INTENSIVE CARE; PRIORITY JOURNAL; RISK ASSESSMENT; SCORING SYSTEM; STATISTICAL ANALYSIS;

EID: 0029086153     PISSN: 00123692     EISSN: None     Source Type: Journal    
DOI: 10.1378/chest.108.2.490     Document Type: Article

References (49)

1. Kalb PE Miller DH Utilization strategies for intensive care units JAMA 261 1989 2389 2395
2. Luce JM Ethical principles in critical care JAMA 263 1990 696 700
3. Teres D Civilian triage in the intensive care unit: the ritual of the last bed Crit Care Med 21 1993 598 606
4. Society of Critical Care Medicine Ethics Consensus statement on the triage of critically ill patients. JAMA 271 1994 1200-1203
5. Popovich J Intermediate care units: graded care options Chest 99 1991 4 5
6. Bone RC Balk RA Noninvasive respiratory care unit: a cost effective solution for the future Chest 93 1988 390 394
7. Elpern EH Silver MR Rosen RL The noninvasive respiratory care unit: patterns of use and financial implications Chest 99 1991 205 208
8. Mazer CD Byrick RJ Sibbald WJ Postoperative utilization of critical care services by cardiac surgery: a multicenter study in the Canadian healthcare system Crit Care Med 21 1993 851 859
9. Franklin CM Rackow EC Mamdani B Decreases in mortality on a large urban medical service by facilitating access to critical care: an alternative to rationing Arch Intern Med 148 1988 1403 1405
10. Byrick RJ Power JD Ycas JO Impact of an intermediate care area on ICU utilization after cardiac surgery Crit Care Med 14 1986 869 872
11. Byrick RJ Mazer CD Caskennette GM Closure of an intermediate care unit: impact on critical care utilization Chest 104 1993 876 881
12. Durbin CG Kopel RF A case-control study of patients readmitted to the intensive care unit Crit Care Med 21 1993 1547 1553
13. Snow N Bergin KT Horrigan TP Readmission of patients to the surgical intensive care unit: patient profiles and possibilities for prevention Crit Care Med 13 1985 961 964
14. Bone RC McElwee NE Eubanks DH Analysis of indications for intensive care unit admission: clinical efficacy assessment project: American College of Physicians Chest 104 1993 1806 1811
15. Bone RC McElwee NE Eubanks DH Analysis of indications for early discharge from the intensive care unit Chest 104 1993 1812 1817
16. Sax FL Charlson ME Utilization of critical care units: a prospective study of physician triage and patient outcome Arch Intern Med 147 1987 929 934
17. Marshall MF Schwenzer KJ Orsina M Influence of political power, medical provincialism and economic incentives on the rationing of surgical intensive care unit beds Crit Care Med 20 1992 387 394
18. The Society of Critical Care Medicine Ethics Committee Attitudes of critical care medicine professionals concerning distribution of intensive care resources. Crit Care Med., 22, 1994, 358-62
19. Wagner DP Knaus WA Draper EA Identification of low-risk monitor patients within a medical surgical intensive care unit Med Care 21 1983 425 434
20. Wagner DP Knaus WA Draper EA Identification of low-risk monitor admissions to medical-surgical ICUs Chest 92 1987 423 428
21. Knaus WA Wagner DP Draper EA The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults Chest 100 1991 1619 1636
22. Zimmerman JE (ed) The APACHE III study design: analytic plan for evaluation of severity and outcome Crit Care Med 17(suppl 1989 169 221
23. Knaus WA Wagner DP Zimmerman JE Variations in mortality and length of stay in intensive care units Ann Intern Med 118 1993 753 761
24. Cullen DJ Civetta JM Briggs BA Therapeutic intervention scoring system: a method for quantitative comparison of patient care Crit Care Med 2 1974 57 60
25. Keene AR Cullen DJ Therapeutic intervention scoring system: update 1983 Crit Care Med 11 1983 1 5
26. Schwartz S Cullen DJ How many intensive care beds does your hospital need? Crit Care Med 9 1981 625 629
27. reenberg AG McClure DK Janus CA Nursing intervention scoring system: a concept for management, research, and communication. Lecture notes in medical informatics. Lindberg DAB Reichertz PL 1978 Springer-Verlag New York: 729 73
28. Wagner DP Economics of prolonged mechanical ventilation Am Rev Respir Dis 140 1989 S14 S18
29. Oye RK Bellamy PE Patterns of resource consumption in medical intensive care Chest 99 1991 685 689
30. Wagner DP Draper EA Acute physiology and chronic health evaluation (APACHE II) and medicare reimbursement Health Care Financ Rev 4(suppl 1984 91 105
31. Wagner DP Wineland TD Knaus WA The hidden costs of treating severely ill patients: charges and resource consumption in an intensive care unit Health Care Financ Rev 5 1983 81 86
32. Rapoport J Teres D Lemeshow S Explaining variability of cost using a severity of illness measure for ICU patients Med Care 28 1990 338 348
33. Knaus WA Wagner DP Draper EA The range of intensive care services today JAMA 246 1981 2711 2716
34. Zimmerman JE Shortell SM Knaus WA The value and cost of teaching hospitals: a prospective multicenter, inception cohort study Crit Care Med 21 1993 1432 1442
35. Zimmerman JE Wagner DP Draper EA Improving intensive care unit discharge decisions: supplementing physician judgement with predictions of next day risk for life support Crit Care Med 22 1994 1373 1384
36. Miller RG The jackknife—a review Biometrika 61 1974 1 15
37. Hanley JA McMeil BJ The meaning and use of the area under a receiver operating characteristic (ROC) curve Radiology 143 1982 29 36
38. Schuster DP Predicting outcome after ICU admission—the art and science of assessing risk Chest 102 1992 1861 1870
39. Knaus WA Wagner DP Individual patient Decisions Crit Care Med 17(suppl 1989 S204 S209
40. Franklin C Rackow EC Mamdani B Triage considerations in medical intensive care Arch Intern Med 150 1990 1455 1459
41. Franklin C Mathew J Developing strategies to prevent in hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event Crit Care Med 22 1994 244 247
42. Sax FL Charlson ME Medical patients at high risk for catastrophic deterioration Crit Care Med 15 1987 510 515
43. Thibault GE Mulley AG Barnett GO Medical intensive care: indications, interventions and outcomes N Engl J Med 302 1980 938 942
44. Zimmerman JE Knaus WA Judson JA Patient selection for intensive care: a comparison of New Zealand and United States hospitals Crit Care Med 16 1988 318 326
45. Fineberg HV Scadden D Goldman L Care of patients with a low probability of acute myocardial infarction: cost effectiveness of alternatives to coronary care unit admission N Engl J Med 310 1984 1301 1307
46. Groeger JS Guntupalli KK Strosberg M Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization Crit Care Med 21 1993 279 291
47. Charlson ME Intermediate care: how do we know it works? Arch Intern Med 148 1988 1270 1271
48. Sirio CA Tajami K Tase C An initial comparison of intensive care in Japan and the United States Crit Care Med 20 1992 1207 1215
49. OH TE Hutchinson R Short S Verification of the acute physiology and chronic health evaluation scoring system in a Hong Kong intensive care unit Crit Care Med 21 1993 698 705