ICU admit rates

[WallowaWanderer]

Detroit Receiving has a 3.5% ICU admit rate, but Kalamazoo has a 20% ICU admit rate and Lansing has a 31.4% ICU admit rate. Does this make sense to anyone? Are these numbers just really unreliable? Are they being calculated differently (i.e. percent of visits vs percent of admissions)? Is there a more reliable source?

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[BKN]

Detroit Receiving has a 3.5% ICU admit rate, but Kalamazoo has a 20% ICU admit rate and Lansing has a 31.4% ICU admit rate. Does this make sense to anyone? Are these numbers just really unreliable? Are they being calculated differently (i.e. percent of visits vs percent of admissions)? Is there a more reliable source?

You probably have it exactly in your last sentence. Or they could just not have good collection methods.

 

[docB]

Many of the big inner city places see a very high volume of patients but they also see lots of low acuity primary care type stuff. I know we all see primary care in the ED but I'm talking about degree. In areas with a more functional population more people will get their primary care outside of the ED. Consequently the acuity rate for that ED goes up. It's a paradox that can make the acuity seem lower in inner city places. In reality they probably see more high acuity patients but those patients are a lower percentage of their volume.

 

[BADMD]

Many of the big inner city places see a very high volume of patients but they also see lots of low acuity primary care type stuff. I know we all see primary care in the ED but I'm talking about degree. In areas with a more functional population more people will get their primary care outside of the ED. Consequently the acuity rate for that ED goes up. It's a paradox that can make the acuity seem lower in inner city places. In reality they probably see more high acuity patients but those patients are a lower percentage of their volume.

Actually, I was going to say the opposite. The acuity is so high that sometimes things that would go to an ICU in 'burbs, becomes a floor admit downtown.

 

[WallowaWanderer]

Yeah, I've thought about these explanations. But it still doesn't add up. Detroit Receiving has a total admit rate of 25% of their total 80,000 patients = 20,000 patients admitted. So, 3.5 percent (ICU admit rate) of that would be 700 patients. On the other had, at Lansing they see 100,000 with a 25% admit rate = admitting 25,000 patients. The ICU admit rate is 30%, so that means they have 7500 ICU patients annually. Accordingly, Lansing sees ten times the critical care volume that Receiving does. Does that make sense to anyone? Even if you were to assume that for Detroit it's 3.5% of all ED visits, then it would be 2800 - about 1/3 what Lansing sees.

 

[ERMudPhud]

If your ICU is already full and nobody's going to a long term vent farm because they don't have insurance its pretty tough to take new ICU admits. So what might be an ICU admit somewhere else goes to the floor 'cause there's nowhere else to put them. We did a lot of that in NYC. Admiting vented patients to the floor because we had nowhere else to put them. I suspect Detroit's low 3.5% is a combination of calculating it as percent of all visits combined with the above effect plus perhaps some dilution by indigent care issues which docB alluded to. It may also be that places that serve as large referral centers are including patient transferred into their ICU's in their numbers

 

[southerndoc]

We admit 25% of our patients, and of those about 10% go to the ICU. I couldn't imagine a higher volume of ICU patients. The other day I had 5 ICU patients at one time -- respiratory failure on a vent, a GI bleeder with a Cordis, two DKA'ers with pH's in the 7.05 range (one with a glucose of 1700), and an active CHF'er on a ntg drip with a markedly positive troponin. Fun times.

 

[WallowaWanderer]

We admit 25% of our patients, and of those about 10% go to the ICU. I couldn't imagine a higher volume of ICU patients. The other day I had 5 ICU patients at one time -- respiratory failure on a vent, a GI bleeder with a Cordis, two DKA'ers with pH's in the 7.05 range (one with a glucose of 1700), and an active CHF'er on a ntg drip with a markedly positive troponin. Fun times.

That's exactly what I want in a training program . . . so should I be looking at an urban place like Detroit or a more serene place like Lansing or Kalamazoo?

 

[Jeff698]

That's exactly what I want in a training program . . . so should I be looking at an urban place like Detroit or a more serene place like Lansing or Kalamazoo?

Don't feel like you need to limit your search to urban centers for lots of sick medical patients. Most tertiary care centers will offer you this type of population. Lord knows, we see tons of very sick patients. Central lines, tubes and pressors are very common and we're not exactly in a dense urban area.

You want to be were there sick people go. They go to tertiary care facilities. Look for those and you'll find the sick patients.

As for the ICU admit rate, I've worked in several places now and see what a huge difference floor capabilities make. In one place, I have to put anyone with a DBP > 100 in the ICU!

At S&W, unless you're on a vent, you're gonna have a hard time getting into the unit. I used to think pressors were an automatic unit admission. Not so much anymore. I've sent my last couple of CHFers on BiPAP and NTG drips to the floor.

FWIW, our numbers are around 23% admits and 7% unit admissions (of total admits; ~1-2% of total visits).

Take care,
Jeff

 

[WallowaWanderer]

Don't feel like you need to limit your search to urban centers for lots of sick medical patients. Most tertiary care centers will offer you this type of population. Lord knows, we see tons of very sick patients. Central lines, tubes and pressors are very common and we're not exactly in a dense urban area.

You want to be were there sick people go. They go to tertiary care facilities. Look for those and you'll find the sick patients.

As for the ICU admit rate, I've worked in several places now and see what a huge difference floor capabilities make. In one place, I have to put anyone with a DBP > 100 in the ICU!

At S&W, unless you're on a vent, you're gonna have a hard time getting into the unit. I used to think pressors were an automatic unit admission. Not so much anymore. I've sent my last couple of CHFers on BiPAP and NTG drips to the floor.

FWIW, our numbers are around 23% admits and 7% unit admissions (of total admits; ~1-2% of total visits).

Take care,
Jeff

Jeff,

Thanks for the input. That makes sense to me

 

[Seaglass]

I think you're on the money with the idea that the numbers are calculated differently and also that there are different criteria for what is an "ICU" patient. I have put a lot of stuff into the ICU here that would go to intermediate care where I trained. A lot of it has to do with nursing protocols and staffing, not as much the actual acuity of the patient.

 

[missmod]

At the Philadelphia VA, floor beds do not have telemetry and nurses take vitals only 2 times per day. All "rule out MI" patients would wind up going to the MICU, as well as anybody who needed insulin (IV), blood transfusions, vitals or labs more than once a day, etc. What counts as an "ICU" at one place may not count as an "ICU" at another institution...