Intensive Care Units (ICUs) are reserved for the sickest patients, right?

Maybe, or perhaps more accurately, they are at least part of the time.

That’s the surprising contention of a group of University of Michigan researchers who have published an article in the New England Journal of Medicine suggesting that EHRs could be better used to predict which patients will benefit the most from ICU treatment.

As they sum up the current situation, “Triage decisions frame the subsequent course of care for all hospitalized patients, yet in the case of critical care admissions, these decisions vary widely among hospitals, which suggests that there is at least some misallocation of resources. Reliable, individualized, EHR-based predictions of risk have the potential to improve our ability to triage — and hence care for — patients.”

Recommending “more targeted incentives for meaningful use of HIT”, they point to research they conducted in which they “examined the records of a cohort of 101,912 patients admitted for reasons other than surgery to 121 VA acute care hospitals in fiscal year 2009.  . . For the most common noncardiac diagnoses, we found that, in keeping with (standard guidelines), patients with a high severity of illness were much more likely to be admitted to the ICU than were patients with a low severity of illness. In sharp contrast, for common cardiac diagnoses, severity of illness played a negligible role in ICU-admitting decisions.”

In other words, cardiac patients with the greatest need may not be getting appropriate ICU care.

Naturally, in an age when scarcity of resources is a dominant theme in healthcare discussions, figuring out how to predict more accurately the kinds of care a patient will need could be quite helpful, to put it mildly.

At the very least, these researchers “suggest that additional work is needed both to determine who benefits from critical care and to identify what indications for ICU use — other than severity of illness — have merit. . . Data from the EHR offer us the chance to reexamine and improve the value of critical care.  Incentives for reaching HIT targets related to patient triage could accelerate the research and collaboration necessary to take full advantage of this opportunity.”