An Explanatory Mixed-Methods Study of Intensive Care Unit Net Benefit: Triage and Trajectory for Sepsis and Acute...

Area of Science:

• Critical Care Medicine
• Health Services Research
• Hospital Administration

Background:

• Patients with sepsis and acute respiratory failure face high mortality risks, yet optimal triage strategies to intensive care units (ICUs) or general wards remain unclear for those not requiring immediate life support.
• Limited evidence guides hospital triage decisions for capacity-sensitive conditions, impacting patient outcomes and resource allocation.
• Understanding factors influencing triage and the net benefit of ICU versus ward care is crucial for improving patient management.

Purpose of the Study:

• To identify factors influencing hospital triage of patients with capacity-sensitive conditions.
• To determine factors explaining observed variations in ICU versus ward care benefits for these patients.
• To investigate how hospital practices affect patient outcomes in sepsis and acute respiratory failure management.

Main Methods:

• An explanatory sequential mixed-methods study involving 27 hospitals across two health systems.
• Retrospective cohort analysis to calculate hospital-specific ICU net benefit for sepsis/acute respiratory failure patients.
• Qualitative interviews with 118 clinicians and administrators at high and low ICU net benefit hospitals.

Main Results:

• Hospital clinicians agreed on the importance of predicting patient trajectory for triage but varied on optimal emergency department interventions.
• Key differences between high and low ICU net benefit hospitals centered on responses to unexpected clinical deterioration in admitted patients.
• Hospitals with lower ICU net benefit demonstrated more robust rapid response and surveillance for ward-admitted patients experiencing decompensation.

Conclusions:

• Proactive rapid response programs delivering on-location critical care can enhance ward net benefit.
• Implementing ICU-level critical care interventions on general wards may improve outcomes for critically ill patients without increasing ICU-associated harms.
• Optimizing ward-based critical care delivery can mitigate risks for sepsis and acute respiratory failure patients, improving overall hospital care efficiency.