“The MICU Is Full”: One Hospital’s Experience with an Overflow Triage Policy

Abstract

Coronary care units (CCUs) are designed and staffed to care for patients with cardiovascular disease, while medical intensive care units (MICUs) are specially organized and staffed for the care of patients with noncardiovascular critical illness. Because the demand for MICU beds often exceeds their availability, patients in need of critical care often experience delays in admission and transfer to such specialized units, which may result in preventable harm. In response to this challenge, during times of MICU bed nonavailability Jacobi Medical Center (Bronx, New York) activates a policy whereby patients with noncardiovascular critical illness are admitted to a cardiology-staffed CCU for critical care to be delivered in a timely manner. A study was conducted to determine the impact of this novel overflow policy on patient outcomes and patient safety metrics. A retrospective analysis was performed of all 1,104 patients discharged from the CCU with a noncardiovascular primary diagnosis between January 1, 2006, and December 31, 2009. Patient demographics, overall hospital length of stay (LOS,) ICU LOS, in-hospital mortality, 30-day hospital readmission status, and severity of illness were compared with a reference cohort of 2,041 patients who were discharged from the MICU during the same period. The severity-adjusted in-hospital mortality rate, 30-day readmission rate, ICU LOS, overall LOS, and patient safety outcomes for the CCU cohort were similar to those of the MICU cohort. A policy that directed critically ill patients to a CCU instead of an MICU during times of bed nonavailability appeared to be a safe practice. With careful planning, CCU bed resources might be an acceptable alternative for the delivery of critical care in an environment of constrained MICU bed access.