Background: The demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability. Methods: A single center, prospective, observational study was conducted among consecutive patients in whom an evaluation for ICU admission was requested during times of ICU overcrowding, which comprised the months of April and May 2014. Results: A total of 95 patients were evaluated for possible ICU admission during the study period. Their mean APACHE-II score was 16.8 (median 16, range 3 - 36). Sixty-four patients (67.4%) were accepted to ICU, 18 patients (18.9%) were triaged to SDU, and 13 patients (13.7%) were admitted to hospital wards. ICU had no beds available 24 times (39.3%) during the study period, and in 39 opportunities (63.9%) only one bed was available. Twenty-four patients (25.3%) were evaluated when there were no available beds, and eight of those patients (33%) were admitted to ICU. A total of 17 patients (17.9%) died in the hospital, and 15 (23.4%) expired in ICU. Conclusion: ICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the likelihood of being admitted to ICU. Alternative locations outside the ICU in which care for critically ill patients could be delivered should be considered during times of extreme ICU-bed shortage.J Clin Med Res. 2014;6(6):463-468doi: http://dx.doi.org/10.14740/jocmr1939w
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机译：背景：对重症监护之类的专业医疗服务的需求通常超出了可用性，因此，重症监护病房（ICU）病床的配给通常会导致难以进行分诊的决策。在决定是否允许患者加入ICU的过程中，许多因素都可能起作用，包括疾病的严重程度以及仅限于这些病房的特定治疗的需求。尽管分诊决定将仅基于患者和机构水平的因素，但在ICU床位较少的情况下，强化医生可能会做出不同的决定。这项研究的目的是评估在有限的床位可用时间内转诊至ICU的患者的特征。方法：在2014年4月和2014年5月期间，对ICU拥挤期间要求ICU入院的连续患者进行了一项单中心，前瞻性观察性研究。结果：共评估了95例患者研究期间可能接受ICU。他们的平均APACHE-II得分为16.8（中位数16，范围3-36）。 64例患者（67.4％）被纳入ICU，18例患者（18.9％）被分类为SDU，13例患者（13.7％）被送往病房。在研究期间，ICU没有可用的床24次（39.3％），在39个机会中（63.9％），只有一张床可用。没有可用床位时评估了24例患者（25.3％），其中8例患者（33％）被纳入了ICU。共有17名患者（17.9％）在医院死亡，而15名患者（23.4％）在ICU死亡。结论：ICU病床是一种稀缺资源，其需求会定期超过供应，从而引起人们对病床数量有限期间资源分配机制的担忧。在我们的机构中，分诊决定与ICU可用床位数，年龄或性别无关。疾病严重程度（由APACHE-II评分表示）与被ICU收治的可能性之间存在线性关系。在重症监护病床床位严重短缺的时候，应考虑在重症监护病房之外可以为重症患者提供护理的其他地点。JClin Med Res。 2014; 6（6）：463-468doi：http://dx.doi.org/10.14740/jocmr1939w
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