Characteristics and Outcomes of Patients Referred but Declined for ICU Admission in a Resource-Limited Setting in South Africa
George L. Anesi, Nqobile Ndadane, Jonathan Invernizzi, Saajid Ally Alladeen, Arisha Ramkillawan, Stella M. Savarimuthu, Robert D. Wise, Michelle T. D. Smith, Zane Farina,OBJECTIVES:
ICU beds are a limited resource and assessing net benefit from ICU admission remains incompletely understood. We sought to examine characteristics and outcomes of patients referred but declined for ICU admission, stratified by clinician-perceived likelihood of ICU benefit.
DESIGN:
Descriptive, retrospective cohort study.
SETTING:
Two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2022 to June 2022.
PATIENTS:
Adult ICU-referred patients classified into four triage cohorts by clinician-assessed acuity and ICU triage status: ICU admissions; high-acuity capacity-declined ICU referrals; high-acuity prognosis-declined ICU referrals; and low-acuity prognosis-declined ICU referrals.
INTERVENTIONS:
None.
MEASUREMENTS AND MAIN RESULTS:
We report descriptive statistics of ICU-referred patient characteristics stratified by triage cohorts and mortal status. Among 866 ICU referrals, 469 patients (54.2%) were admitted, and 397 patients (45.8%) were declined for ICU admission. ICU admissions had an observed all-cause 30-day hospital mortality of 27.7%. Among declined ICU referrals with nonmissing triage priority scores (
CONCLUSIONS:
In one sampling in the South African public healthcare system, many patients are referred but declined for ICU admission due to perceptions of being both “too well” or “too sick” to benefit and due to bed capacity, with a proportion of such patients experiencing potential clinical deviations from triage-expected trajectories.