What "qualifies" a patient to be admitted to ICU

BelgianRN · Feb 12, 2012

I work in an ICU and we get "abused" on a daily basis for babysitting duties if we'd let them. But I agree it isn't a fight between nurses it's a fight between charge nurse and referring physician or even between two physicians. I can give you a ton of examples of this abuse but then the post drags on and on. Generally when we get admissions of this kind and I feel they don't qualify for ICU care I'll write a "safety report" stating all the reasons and have management fight it out as they get payed more than I do.

And personally I don't like the "easy ICU" patients. Because generally they are not the easy ones ^^. They are the ones that complain about the sounds of alarms and pumps, can't sleep because they get checked out every two hours, call for anything and everything. The ones that consider the ICU a 5 star hotel... So in my experience they are usually more time consuming than an unstable patient that is sedated and isn't complaining other than making a statement with his crappy BP. Those "easy ICU patients" are the ones I'll generally tell the attending if this patient isn't out by tonight I swear I'm calling in sick or you better make sure he is tubed and vented. And we have this great attending that will usually listen.

czyja, MSN, RN · Feb 16, 2012

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. .

Good heavens, I am glad you made it throught that. Those mid-line shifts can be most unpleasant.... What caused you to get treatment? Did you sieze or were you feeling odd?

In your case I suspect it was probably the q1 hr neuro checks that upgraded you to the ICU. No way they would have the time to do that in M/S or even most PCUs.

MomRN0913 · Feb 16, 2012

Good heavens, I am glad you made it throught that. Those mid-line shifts can be most unpleasant.... What caused you to get treatment? Did you sieze or were you feeling odd?
In your case I suspect it was probably the q1 hr neuro checks that upgraded you to the ICU. No way they would have the time to do that in M/S or even most PCUs.

Well, I am sure you realize you were a ticking time bomb at that time. And I am glad everything worked out for you.

My dad, his wife, and my ex-husband are court officers in NYC. They essentially do nothing all day. They like to say "we don't get paid for what we do, it's what we might have to do"

So, some of these walkie talkies like yourself belong, because at the blink of an eye, you don't know what you MIGHT have to do.

And the walkie-talkies could be very demanding and time consuming. I prefer them intubated and sedated:)

vanburbian · Feb 16, 2012

Criteria for reimbursement in ICU is variable, I used to do UR, and fought hard with many MD's about un necessary ICU admissions that I knew we would not be able to charge ICU rates for.

Oddly, an insulin gtt alone does not meet criteria- need a Bhb > (28 I think ?) or BG > 500, or acidosis.

In general, it can be a drip, bipap/cpap/intubation, blood > 3 units, stemi, etc that meet criteria. Anything basically that requires monitoring and could result in a potential treatment change q 1 hour, and even OD's for the first 24 hours meet criteria.

All head bleeds, open chest surgeries, large vascular or abdominal surgeries, traumas with amputations, burns, sepsis req 3 or > antibx, or lactate > 2.5, etc.-

google InterQual criteria for ICU admission.

But, having just gone thru this yesterday trying to get a patient up to ICU from ER and having multiple issues, I agree with many other posters- don't argue with the ER nurse- we don't make the decision- argue with the doc's.

umcRN, BSN, RN · Feb 16, 2012

Good heavens, I am glad you made it throught that. Those mid-line shifts can be most unpleasant.... What caused you to get treatment? Did you sieze or were you feeling odd?
In your case I suspect it was probably the q1 hr neuro checks that upgraded you to the ICU. No way they would have the time to do that in M/S or even most PCUs.

I had headaches actually, for about 6 months, initially I thought they were migraines (nausea, vomiting and fatigue accompanied them), and of course my PCP agreed with me. I saw her twice but when I started having vision problems (vision loss, tunnel vision, flashers) I sought out a neurologist on my own, I was diagnosed that afternoon, spent about a week on steroids and seizure meds and had surgery a week later (they waited a week because I had been on every NSAID in the book for months one of which included aspirin and my coags were off).

My surgery was this past December (the 6th) and I started back at work last week so everything has gone really well.

umcRN, BSN, RN · Feb 16, 2012

Well, I am sure you realize you were a ticking time bomb at that time. And I am glad everything worked out for you.
My dad, his wife, and my ex-husband are court officers in NYC. They essentially do nothing all day. They like to say "we don't get paid for what we do, it's what we might have to do"
So, some of these walkie talkies like yourself belong, because at the blink of an eye, you don't know what you MIGHT have to do.
And the walkie-talkies could be very demanding and time consuming. I prefer them intubated and sedated:)

Haha i'm actually quite glad I had no idea that I was a ticking time bomb :lol2: I would have been waaay more stressed out. All that really concerned me was getting rid of the headaches. Looking back on it of course I realize that things could have been way worse than a few months of headaches and a bad haircut (my incision went ear to ear and so did my shaved hair) but at the time I wasn't really thinking of that so much.

I also work in an ICU and prefer them intubated and sedated of course! :rolleyes:

(though I am glad I have no recollection of being intubated and no memory of when they extubated me. I do remember waking up in the ICU pretty p*ssed off and kicking though, better than being in a coma IMO)

Being an ICU nurse though I tried very hard not to be a demanding patient...I also tried really hard to not turn off my own beeping pumps!

xtine618 · Feb 21, 2012

The charge nurse should be thankful to have an easy ICU patient and not stir up a hornet's nest.

It's not about having an easy ICU patient (I'd like one of those every now and then), it's about a pt who doesn't meet ICU requirements taking up a bed and a nursing assignment that could be needed by a code, a trauma, etc. And sometimes the docs don't realize they're taking up the last available ICU bed.

psu_213, BSN, RN · Feb 21, 2012

I had a pt with a peritonsillar abcess extending to the pharengeal area. No airway issues at present. Started on ABX and IV steroids in the ER. On no gtts, able to walk, talk, swallow. Because of potential airway issues it was decided he would go to the ICU. I wanted to take him up in a wheelchair just to see the reaction of the nurses up there. Yes, a potentially dangerous situation, but I think the ICU was a bit much.

Anyway, gtts are not a criteria for ICU admission. The only gtts that require and ICU admission are gtts for BP control (e.g. NTG for BP, sodium nitroprusside, etc.). Tele floors can take NTG for chest pain. Insulin gtts do not require the ICU.

If the ER doc wants the ICU and then pt is not appropriate then the ICU attending/the intensivist needs to speak with the ER doc...not the ICU charge nurse.

beckster_01, BSN, RN · Feb 22, 2012

I am not an ICU nurse, but our patients get sent to the ICU if the require any q1h/q2h checks (neuro, dopplers, etc.), or if they have issues with blood pressure/heart rate that are not responsive to a couple bolus doses of medication. We prefer to send our patients to the ICU when they are still stable, but are at risk for becoming unstable. Usually the rapid response team/CRN is involved in making sure it is an appropriate transfer. The only exception is that we do take insulin drips, but no more than 4 patients on an insulin gtt may be on our floor at once. That way one nurse will never have to take two drips.