Intensive care units in the triage mode: an organizational perspective

Decisions to admit and discharge patients to and from the intensive care unit (ICU) when beds are scarce should be made in accordance with the triage principle--that is, allocate resources on the basis of the ability to benefit from intensive care. However, uncertainty over resource capacity and patient prognosis limits the ability of decision makers to use this prioritization principle and results in ICUs containing inappropriately placed patients who are denying or delaying care to patients who could benefit more. Using Jay Galbraith's "information processing" model, ICU admission and discharge decision making is described. Organizational strategies to reduce uncertainty and improve decision making are discussed, including strengthening the management role of the ICU physician director and employing prognostic instruments (e.g., mortality prediction models) to share and process information.