Inappropriate ICU admissions

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Although the majority of our patients require ICU level of care, we occasionally get "dumped" on by the triage doc. For example, I had a old codger with severe constipation who was ordered for Q1 tap water enemas!! The reason we got the patient was that it was too much work for the floors. My end of the unit stunk to high heaven!!

Anyone else experience this "dumping" phenomenon?

Don't know what type of hospital you're working at. However, most private hospitals will not allow inappropriate ICU patients to remain in ICU for very long, because insurance will not reimburse them for the $10,000+/day average ICU cost. It happens where I work because Uncle Sam (and all of us) are paying the bill!!

drop a dime.....this is fraud.

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Specializes in icu/er.

here is aprime example. last wk we got a direct admit from a primary care clinic for 89yo who had cva. apparently on the way to the hospital from the docs office his condition worsened so they pulled inot the er. the er did the usual cva work-up on him. by now the poor guy is unresponsive with very low gcs, alternating agonal resp. the family promptly made notice to the er doc this guy was a full dnr. instead of sending him to the floor to be with family they admitted him to the unit on 3lpm o2 and 1/2ns @ 75/hr....thats it!! ******* unbelievable. in our hospital docs have to round atleast once q 24hrs on pts on non acute units, and a pt in a acute setting (icu) must be rounded on twice q day. well the patient got admitted to the unit around 1030am primary doc didnt lay eyes on the patient until 0800 the next morn. we informed him of the hospital policy & he just sort of shrugged his shoulders & stated "well it isnt like there was something i was really going to do that couldnt wait till today". now that was the wrong thing to say in front of us, so the icu team leader took the issue up with our critical care doc's and they claim they are going to bring it up at the next acute care meeting. but this am when i left the unit there was 10 pts & 3 were endstage dnrs. nothing changes.

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drop a dime.....this is fraud.

I don't know if it's fraud but it certainly is a waste of medical resources and it accounts for some of the ever escalating cost of health care in this country. Who would I drop a dime to? It's the attending docs who triage and accept the admission into the ICU . . . many of us have questioned the attending regarding their reasoning for accepting the "inappropriate admission" and we usually get the reply, "altered mental status" or "hypotension".

From reading some of the other posts, it's not just the federal hospitals that do this but I wonder how the private hospitals get reimbursed for their inappropriate ICU admissions?

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Specializes in icu/er.

i think part of our problem is that the docs get to charge differently for acute care patients vs genreal care patients. if our erp's admit a patient to icu they get to charge a higher service fee for thier reimbursement and if they have x number of icu admits per month they get a certain amount of bonus kick back from the hospital. the same with primary docs, they too can charge a higher reimbursement for seeing a pt in the icu vs. med/surge floor. matter of fact we have one family practice doc trying to pay off his 3rd divorce so he has alot of admits to the icu for sub-acute patients & he's our biggest offender. if you follow the money trail you can find the answer.

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i think part of our problem is that the docs get to charge differently for acute care patients vs genreal care patients. if our erp's admit a patient to icu they get to charge a higher service fee for thier reimbursement and if they have x number of icu admits per month they get a certain amount of bonus kick back from the hospital. the same with primary docs, they too can charge a higher reimbursement for seeing a pt in the icu vs. med/surge floor. matter of fact we have one family practice doc trying to pay off his 3rd divorce so he has alot of admits to the icu for sub-acute patients & he's our biggest offender. if you follow the money trail you can find the answer.

Aha! You may be right which would explain a lot. I was always under the impression that "non-ICU" patients who were in an ICU bed would only be reimbursed at the lower acuity rate. When I was working in a private hospital, whenever we extubated our CABG patients, as long as they were stable, they were transferred to the stepdown unit within the hour because of the reimbursement issue.

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Specializes in Critical Care (ICU and ER).

Happens all the time. Our docs think the staffing on the floor, between GNs and lazy nurses, is unsafe. We had a TURP admitted for CBI and the doc justified the admission because "If I put him on the floor they'll let the bags run out and he'll clot off".

Case management wrote the following on a post-op pts progress notes: "Dr, if this patient is stable, transfer him to the floor" the doctor responded "I would but I'd rather not have them make another med error, thanks!" Total BS because that's perminent record and just inpappropriate however I did laugh to myself.

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Specializes in icu/er.
Happens all the time. Our docs think the staffing on the floor, between GNs and lazy nurses, is unsafe. We had a TURP admitted for CBI and the doc justified the admission because "If I put him on the floor they'll let the bags run out and he'll clot off".

Case management wrote the following on a post-op pts progress notes: "Dr, if this patient is stable, transfer him to the floor" the doctor responded "I would but I'd rather not have them make another med error, thanks!" Total BS because that's perminent record and just inpappropriate however I did laugh to myself.

yep, or they'll reply with a snide comment like " if i sent them to the floor, the nurses out there will page me all ******* night about this pt, i'll just leave'em in the unit cause i know ya'll take care of issues without calling me all night long." this statment is just pure bullstool....

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Specializes in Adult Critical Care, Cardiothoracic Surgery.
yep, or they'll reply with a snide comment like " if i sent them to the floor, the nurses out there will page me all ******* night about this pt, i'll just leave'em in the unit cause i know ya'll take care of issues without calling me all night long." this statment is just pure bullstool....

same where I work too! if floor nurses page a doc enough about any problem, chances are they'll get an ICU transfer order. Since we have a 2:1 patient-nurse ratio and we are ACLS certified, the docs think they won't be called all night.

Here's were I'm confused...how can a non-profit public hospital (not just the docs) benefit from inappropriate ICU admissions?

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Sometimes we have particular physicians who insist their patients stay in the ICU until almost discharge! I mean technically they do not belong in an ICU but the docs will keep them there anyway just because they like how closely the patients are monitored and want to play it safe. I don't know if it has something to do with billing? Do they get paid more if they are in the ICU? I wonder how they justify them being in the ICU without the clinical reasons behind it. But I see it often.

I wonder why healthcare is so expensive. Maybe we just need to re-evaluate where the money is being spent. i.e. unnessasary ICU stays could be one of them.

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Specializes in CVICU, SICU, PCU, ER.

I work in SICU and get lots of overflow. We constantly take floor patients that require "baby-sitting" or just plain overflow. We also get all of the pediatric overflow because MICU RNs don't have to carry PALS at my hospital. I think this ICU dumping happens everywhere.

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I work in a large level 3 NICU, when the PICU and Pedi CICU are full (because they're half out size) they try to send us their "babies" aka 4-6 month olds that are entirely inappropriate for us to have

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I am so happy that there is a post on this ongoing issue. I work in 310 bed community based hospital. We have two ICU floors and I would say 8 out of the 14 pts on our floor DO NOT NEED ICU! We have one particular surgeon that sends his laminectomy pts to the ICU for the night and then discharges them from ICU. We get TURP pts because the doctor fears the floor nurse will let the irrigation bag run dry. And my favorite, we get the DNR/DNI pt that is on the floor and develops SOB and needs bipap and no other floor including our stepdown can take care of a bipap pt??!!!! WHAAT?! We now established Code Silvers which are rapid response team, and guess who does RRT, the ICU nurse! More often then not, the floor nurse should have just used their brain and used critical thinking skills that our nursing professors drilled into us and figured it out instead of passing it along to the ICU nurse to deal with. The list goes on. Im an ICU nurse, if I wanted to deal with stable pts I would have worked on the floor or mother baby. I like my pts vented and sedated with 23456 gtts thank you!

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