[Refusal of admission in intensive care unit]

Currently, the demand for intensive care (ICU) exceeds supply leading to refuse admission of patients who are judged to be too ill or too well to benefit form ICU. The refusal is justified either by the lack of benefit for the individual patient or on the basis of the "distributive justice" ("triage") concept. Guidelines and objective data regarding the process of refusal are lacking and identification of patient who can really benefit from ICU is extremely difficult. Furthermore, some studies have shown that refusal of admission to the ICU may be associated with an increased risk of mortality. Nurses and doctors appreciation of futility and quality of live are frequently unreliable. Each ICU should develop admission and discharge policies and procedures, in accordance with a team representing medicine, nursing and hospital administration.