Health IT Seen as Gateway to Critical Care

Health information technology (IT) can be used effectively to identify the most seriously ill patients and those who would benefit most from critical care in intensive care units, according to authors of a perspective article published on Jan. 30 in The New England Journal of Medicine.

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Citing their own study of 101,912 patients admitted to 121 Veterans Affairs acute care hospitals in 2009, the authors found that patients with a high severity of illness were much more likely to be admitted to the intensive care unit than those with a low severity of illness, but that severity of illness played a negligible role in clinical decisions to admit patients with common cardiac diagnoses to intensive care units.

They note that one possible explanation for their findings is that cardiac patients may have a need for critical care that isn't captured by illness severity scores. Other potential explanations are that cardiac patients who need telemetry may be over-represented in the patient population of intensive care units, that cardiac patients were admitted for intensive care because physicians were following a treatment protocol or that these patients were waiting for a transfer to another hospital with interventional services. In addition, physicians may believe that cardiac patients are at higher risk than other patients for sudden and unexpected adverse events, so they routinely admit relatively healthy patients with cardiac illnesses to intensive care units.

As taking care of the sickest patients is the primary role of intensive care units, the authors suggest that additional research is needed to determine which patients benefit from critical care and what indications for admittance to an intensive care unit, other than a patient’s severity of illness, might be valid for admittance. Further, to make sure the sickest patients and those who will benefit most receive critical care in intensive care units, the authors recommended using data from electronic health records to triage patients on admittance to a hospital. "That, we believe, would truly be meaningful use of health IT," they add.

Keywords: Intensive Care Units, Intensive Care, Health Resources, Clinical Protocols, Medical Informatics, Critical Care, New England

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