Mixed-Methods Cohort Study of Acute Respiratory Failure and Sepsis Patients Produces 10th Publication

We are pleased to announce a big milestone for the ICU Net Benefit Study Group: the publication of the 10th manuscript from this project!

ICU Net Benefit launched in 2017, led by Drs. George Anesi and Scott Halpern with funding from the National Heart, Lung, and Blood Institute. This mixed-methods study in 27 hospitals across Penn Medicine and Kaiser Permanente of Northern California sought to determine which patients with acute respiratory failure and/or sepsis benefit from ICU admission and which emergency department, ward, and ICU characteristics contribute to such net ICU benefits.

“ICU Net Benefit seeks to answer a fundamental question: Which patients truly benefit from being admitted to the intensive care unit? The results have the potential to improve triage decisions, healthcare spending, and access to the ICU for patients who need it most.”

Dr. George Anesi

This 10th publication marks the final planned manuscript from the initial grant, and motivates our work as data collection continues for ICU Net Benefit 2.0, also funded by the National Heart, Lung, and Blood Institute. Furthermore, the rich dataset produced by this team has enabled other PAIR Center and external investigators to explore a variety of topics, including mechanisms underlying racial disparities in clinical outcomes, development of equitable mortality prediction models, and optimal clinician staffing ratios in the ICU.

Read all the publications from the ICU Net Benefit Study Group below.

Publications

1. Associations of ICU capacity strain with disposition and outcomes of patients with sepsis presenting to the emergency department (2018)
2. Association of a novel index of hospital capacity strain with admission to intensive care units (2020)
3. Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use (2020)
4. Equitably allocating resources during crises: Racial differences in mortality prediction models (2021)
5. Association of ICU admission and outcomes in sepsis and acute respiratory failure (2022)
6. Characterizing equity of intensive care unit admissions for sepsis and acute respiratory failure (2022)
7. Hospital strain and variation in sepsis ICU admission practices and associated outcomes (2023)
8. Among-hospital variation in intensive care unit admission practices and associated outcomes for patients with acute respiratory failure (2023)
9. Racial disparities in length of stay among severely ill patients presenting with sepsis and acute respiratory failure (2023)
10. An explanatory mixed-methods study of “ICU net benefit”: Triage and trajectory for sepsis and acute respiratory failure (2025)
11. *NEW* Association of ICU patient-to-clinician ratios with mortality across two US health systems (2025)

Editorials and Press Coverage

• The Search for the Optimal Intensive Care Unit Triage Model (2018)
• On Baseball, Counterfactuals, and Measuring Care Delivery Performance at the Emergency Department-Intensive Care Unit Interface (2020)
• Mortality Prediction Models: Another Barrier to Racial Equity in a Pandemic (2021)
• Triage to ICU or ward for sepsis, acute respiratory failure may optimize outcomes for some (Healio, 2021)
• Hospital Capacity Strain as a Window into the Value of ICU Admission: Some Answers, More Questions (2022)
• Systematic racial differences exist in ICU admission among certain ethnicities (2022)
• Who Receives ICU Care during Times of Strain? Triage and the Potential for Racial Disparities (Healio, 2022)
• The Ward or the Intensive Care Unit: Is It All Relative? (2023)
• Racial Disparities Linked to Length of Sepsis and Respiratory Failure Stays (Medpage Today, 2023)
• Policy Proposals for Mitigating Intensive Care Unit Strain: Insights from the COVID-19 Pandemic (2024)
• Beyond Ratios: Rethinking Clinician Workload and ICU Outcomes (2025)