Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.

Abstract:

OBJECTIVE:To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN:Blinded, concurrent data collection, retrospective chart review. SETTING:Surgical ICU. PATIENTS:All patients (n = 308) for whom a surgical ICU bed was requested were studied during a 3-month period. MEASUREMENTS AND MAIN RESULTS:Admitting patterns did not change and no attempts were made to limit admissions to more severely ill patients during times of the greatest shortage of surgical ICU beds. Contrary to findings in previous reports, the severity of illness of patients admitted to the surgical ICU decreased as bed availability and bed census decreased. Bed allocation across surgical services was influenced by factors other than medical suitability. Of major users, cardiothoracic surgery experienced the highest percentage (59%) of all patient admissions and lowest percentage (1.6%) of all denied admissions. General surgery experienced the lowest percentage (15%) of all admissions and highest percentage (10.4%) of all denied admissions, although these patients had the highest average Acute Physiology and Chronic Health Evaluation (APACHE II) scores for all patients admitted (17.7) and for patients denied admission (15.8). CONCLUSIONS:Surgical attending physicians rarely used other open inhouse ICU beds when surgical ICU beds were unavailable. Political power, medical provincialism, and income maximization overrode medical suitability in the provision of critical care services.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Marshall MF,Schwenzer KJ,Orsina M,Fletcher JC,Durbin CG Jr

doi

10.1097/00003246-199203000-00016

subject

Has Abstract

pub_date

1992-03-01 00:00:00

pages

387-94

issue

3

eissn

0090-3493

issn

1530-0293

journal_volume

20

pub_type

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