Metropolitan audit of appropriate referrals refused admission to intensive care

We undertook a three-month prospective cohort study of critically ill adult patients referred to the Intensive Care Units (ICUs) of public hospitals in metropolitan Melbourne and Geelong, Victoria. The aim was to ascertain the prevalence and immediate consequences of "refused" admission amongst patients appropriately referred to the ICU of first choice. Between August 1 and October 31, 1999, 10 (out of 12) public hospitals collected data. Three thousand and four patients were referred to these ICUs, and "refusals" were reported by all hospitals. A total of 282 (9.4%) patients were unable to be admitted to the ICU of first choice, giving a rate of 3.1 "refusals" per day. The reasons for "refusal" were limited staffing (52%) and shortage of beds (46%.) Acute inter-hospital transfer (1.7 per day) was the most common immediate triage outcome (57%). These rates are higher than previously reported figures. We conclude that refused admission to the ICU of first choice, and acute inter-hospital transfer in this region and time period, were common events.