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The Increased Use of the ICU

We are using our ICU's more often than we have in the past, according to a new study. As published in the Academy of Emergency Medicine, George Washington University researchers found a 50 percent increase in Intensive Care Unit admissions between 2002 and 2009. 

As the patient's get older, we are utilizing intensive care more often. The group with the largest jump in ICU admission was those over the age of 85 years. That isn't likely to surprise, given the aging population in the United States.

Yet, the recent study that highlights an increase in hospice admissions only after intensive  and expensive ICU care in the last few days of life highlights the fact that we are still aggressively treating patients in the last chapter of their lives. That Journal of the American Medical Association study appeared with an editorial calling for an end to aggressive hospitalization in end of life care by increasing planning and communication between patients, families and doctors prior those final days. 

The article also notes that patient's also spent up to 5 hours in the Emergency Department waiting to get into the ICU. 

 "Studies have shown that the longer ICU patients stay in the emergency department, the more likely they are to die in the hospital," Pines said. "Better coordination between the emergency department and ICU staff might help speed transfers and prevent complications caused by long emergency department waits," he said.

Ummmmm ... I don't think it is interdepartmental coordination and ED wait time that is increasing these critically ill patient's mortality rate. Might have something to do with the fact that they are sick. 

Patient's are often stabilized the ED prior to transfer to the unit. Often times our ICU won't even take the patient until they are stable for transfer, have all their drips hanging and they have a tube in every orifice. Moreover, with increased admissions, there are increased demands on staffing the ICU. We retain core staffing in the Emergency Department even when our census is low because our patient population in the Emergency Department can change in a heartbeat. Many times we've seen the ER go from empty to full in just a matter of minutes. 

ICU's however, often call off staff when their population is low. Therefore, we are often waiting for a nurse to come in to take our patient. That doesn't mean that there couldn't be better coordination between the Emergency Department and the ICU. Those two departments attract very different personality types.

However, I doubt that lack of coordination between the ICU and the ED that is the primary reason for the increased mortality of patient's needing intensive care in the last years of their life. It may have more to do with the need for better communication between providers and patients and families before those days arrive. 

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