What "qualifies" a patient to be admitted to ICU

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I am an ER nurse in a small 100 bed hospital. We have a combined ICU/CCU, about 20 beds. When ER docs write to admit to this unit, we often times get an argument, with the ICU charge stating that the patient does not have "drips" "qualifying" them to be admitted to ICU. Some diagnoses that this argument has been given for: septic shock, major hemoptysis, etc. Is there actually a criteria requiring "drips"? Is the pathology of certain conditions and the need for close monitoring (2:1 ICU vs 6:1 medical floor) not enough justification?

That will depend on your hospital. Each hospital/ICU has admission criteria for the various units.

Specializes in ICU.

It would depend if the MD feels the patient could be too unstable and need close monitoring as well as the availability of open beds, I suppose.

Specializes in Interventional Radiology.
i am an er nurse in a small 100 bed hospital. we have a combined icu/ccu, about 20 beds. when er docs write to admit to this unit, we often times get an argument, with the icu charge stating that the patient does not have "drips" "qualifying" them to be admitted to icu. some diagnoses that this argument has been given for: septic shock, major hemoptysis, etc. is there actually a criteria requiring "drips"? is the pathology of certain conditions and the need for close monitoring (2:1 icu vs 6:1 medical floor) not enough justification?

it is ironic that you bring this up- i work in icu and apparently hospitals cannot get reimbursed "icu" charges by insurance if a patient does not meet icu criteria. i.e. titrating gtts, bipap, vented, dka, unstable, symptomatic bradycardia, afib rvr, stemi, alines- etc...something that is out of the scope of practice of a m/s rn or pcu rn. being that md wants "closer monitoring" is not criteria for icu...(lol, if it was- boy would we be busy!!!)

icu rn's now have to ask how it is that these patients "meet criteria"...all politics...

Specializes in Interventional Radiology.

i should have clarified- this came up at work this weekend. i got an admit from er- and od "polysubstance abuse". no gtt, no vent, pt on room air..... so i am at a for profit hospital and if patients don't seem to meet criteria- we are suppose to ask why they are coming to us- because the hospital will not get paid icu rate of they don't meet criteria ( as i previously posted- vent, gtt's, dka..etc)

Specializes in Emergency, Case Management, Informatics.

I would let this ICU charge nurse argue directly with the MD that wrote the order and see if she can win the argument. Why even get in the middle of it?

I don't see how a treatment (IV drips) dictates criteria. I would think it has more to do with the need to closely monitor the patient r/t being highly unstable. Example: last week we admitted a guy to ICU with a 398 blood ETOH level, but the only "drip" he was on was a banana bag.

However, 398 blood ETOH is right at the razor's edge of a fatal level. By your charge's criteria, he would not be eligible for ICU, but clearly putting him on a 1:8 med/surg or even 1:4 stepdown is a Very Bad Idea.

Once this patient's ETOH gets down to a less-critical level, he could then be shipped over to med/surg, even if that means he's only in ICU for one day.

Again, let this overbearing charge hash it out with the MD directly.

Specializes in Interventional Radiology.
i would let this icu charge nurse argue directly with the md that wrote the order and see if she can win the argument. why even get in the middle of it?

i don't see how a treatment (iv drips) dictates criteria. i would think it has more to do with the need to closely monitor the patient r/t being highly unstable. example: last week we admitted a guy to icu with a 398 blood etoh level, but the only "drip" he was on was a banana bag.

however, 398 blood etoh is right at the razor's edge of a fatal level. by your charge's criteria, he would not be eligible for icu, but clearly putting him on a 1:8 med/surg or even 1:4 stepdown is a very bad idea.

once this patient's etoh gets down to a less-critical level, he could then be shipped over to med/surg, even if that means he's only in icu for one day.

again, let this overbearing charge hash it out with the md directly.

i agree...an md order is an md order and if that's what they write, then that's what they get and let admin fight it out with the md...however...etoh of 398 would be something that would dictate the need for icu...however.... something say- tox positive for mj and barb's with a completely aao x3, no resp issues, no cardiac issues and asking for a meal tray...ummmm....nope- you need a m/s bed with a sitter......

Specializes in Emergency, Case Management, Informatics.
i agree...an md order is an md order and if that's what they write, then that's what they get and let admin fight it out with the md...however...etoh of 398 would be something that would dictate the need for icu...however.... something say- tox positive for mj and barb's with a completely aao x3, no resp issues, no cardiac issues and asking for a meal tray...ummmm....nope- you need a m/s bed with a sitter......

you're right. in that case, i would clarify with the md whether or not he truly meant to put the patient in icu.

if the md still says yes, i'm not going to question it any further. the patient will not suffer a negative outcome by going to the icu, so the patient goes to icu. as you said, administration can fight it out. the charge nurse should be thankful to have an easy icu patient and not stir up a hornet's nest.

Seems likes just asking about gtts is not enough information, the clinical criteria includes gtts but also other interventions such as those with neurochecks beyond what can be done with 1:4 ratios and require 1:2 or 1:1. Reimbursement is one perspective, but some hospitals or MDs should use their own judgment on the safety of the patient at the time, and worry about payment later.

Specializes in ER, progressive care.
I am an ER nurse in a small 100 bed hospital. We have a combined ICU/CCU, about 20 beds. When ER docs write to admit to this unit, we often times get an argument, with the ICU charge stating that the patient does not have "drips" "qualifying" them to be admitted to ICU. Some diagnoses that this argument has been given for: septic shock, major hemoptysis, etc. Is there actually a criteria requiring "drips"? Is the pathology of certain conditions and the need for close monitoring (2:1 ICU vs 6:1 medical floor) not enough justification?

Not all ICU patients are on drips.

Typically, if a patient needs to be started on a pressor, we start it and then patient is transferred to an ICU bed ASAP. We can have patients on "drips" on my floor, but only certain types and we aren't supposed to titrate them. We still do, anyway, to an extent. I had to put a patient on a dopamine drip and I had to keep titrating it because the patient wasn't tolerating it (too tachy, O2 sats were dropping, BP wasn't within the specified parameters, etc) and there were no available beds in the ICU, so I had to manage it. I wasn't going to leave the drip until I could get an ICU bed. That wasn't safe for the patient.

NTG on my floor can be titrated for chest pain, but not for blood pressure. If they need it for blood pressure, they need to be transferred to ICU.

Cardizem drips can be titrated up to 15mg/hr on my floor. Any higher and they need to be transferred to ICU.

Insulin drips are always in ICU because those patients are on Endotool and require hourly blood sugar checks. It's hard to check sugars hourly (even with the help of CNAs) when you have a ratio of 4:1 on my floor or 6:1 on a medical-surgical floor.

Any time a patient requires closer monitoring (2:1 ratio or even 1:1), they are transferred to ICU.

I was an ICU patient once. I thought it was funny actually, I'd been walking around the ER all day but I had a 6cm x 4cm brain tumor causing mass affect & a 1.1cm midline shift. I was in the neuro ICU with q1 hour neuro checks and had surgery shortly after. I was a "walkie-talkie" (not that they let me once I was admitted!) with no resp support, no drips, no central or arterial lines but still in the ICU. My insurance covered it as well.

Specializes in Pediatrics, ER.

We almost never admit for ETOH...300-400+ blood levels everyday and they sleep it off in the ED and go on their merry way....not even IVF many times.

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