Development of Admission and Discharge Criteria in Intensive Care Units

중환자실의 입실과 퇴실 기준 개발

The purpose of this study was to develop Intensive Care Unit (ICU) admission and discharge criteria that would lead to the appropriate utilization of ICU resources and nursing services. For this study, a conceptual framework was developed through a review of the literature. Then in order to identify the overall health condition of patients in the ICU, and to draw up preliminary criteria, the medical records of 58 patients who were admitted to the ICU of Y Medical Center in Seoul between March, 1999 to February, 2000 of were analyzed. Two expert validity tests were done for the preliminary criteria for admission and discharge with 21 patients over 18 years of age who were admitted patients and for 12 patients who were discharged between May 30, 2000 and June 5, 2000 a clinical validity test was also done. After this process, the final admission and discharge criteria were developed. The results of this study are summarized as follows: 1. After a review of the literature, there were 9 categories for admission criteria cardiologic, gastrointestinal, neurologic, endocrine, post-op care of major surgery, vital signs, laboratory values, and a category of miscellaneous items. Discharge criteria had 3 categories which were vital signs, laboratory values, and a category of miscellaneous items. 2. From the medical records of the 58 patients who were admitted to the ICU, 45 items for preliminary criteria for admission and 17 for discharge were identified. 3. The two expert validity tests showed that of the 45 items 29 admission items received over 75 percent agreement. The 16 admission items which received less than 75 percent agreement were revised or deleted from the admission criteria. Of the 17 discharge items, 11 had over 75 percent agreement and 6 less then 75 percent agreement. These were revised or deleted from the discharge criteria. 4. In the clinical validity test, 14 admission items showed more than 75 percent agreement and 11 discharge items more than 83 percent agreement. 5. The final criteria consisted of 29 items for admission and 11 items for discharge. Since patients being considered for admission to the ICU have complex problems, there is a need to make the decision based on more than a single issue. This tool will insure that the ICU nursing care and treatment resources are appropriately used by allowing a multi-professional health team to make admission and discharge decisions.