Identifying patient subgroups and processes of care that cause outcome differences following ICU vs. ward triage among patients with acute respiratory failure and sepsis

Decisions to admit patients with acute respiratory failure (ARF) and sepsis to intensive care units (ICUs) are highly variable across the US. These triage decisions have a substantial impact on patient outcomes. We found that decisions to admit ARF patients to wards were associated with a 3.8% absolute increase in mortality among a large retrospective cohort. Choices to admit sepsis patients to ICUs resulted in longer length of stay and a 5.1% absolute increase in death in the same cohort. The nationwide impact of such discretionary triage would be exponentially greater. Our findings highlight tremendous opportunities to improve ARF and sepsis outcomes.

This study will expand the cohort of ARF and sepsis patients to include all admissions from 2013 through 2023 across 29 hospitals. We will identify the patient subgroups and processes of care that most strongly contribute to these observed benefits and harms of ICU- versus ward-based care. These data will also allow us to quantify the impact of COVID-19 on ICU and ward triage patterns, care processes, and outcomes among ARF and sepsis patients. Such results will guide optimal care for patients without requiring ICU admission, improve patient outcomes, and reduce costs.

Kaiser Permanente Northern California

National Heart, Lung, and Blood Institute