ICUs: Where do patients come from? Data on source of admissions from large-scale Project IMPACT database

Cerner’s Project IMPACT (Improved Methods of Patient Information Access of Core Clinical Tasks) is – or perhaps was – a database to which many different hospitals submitted information about their intensive care unit (ICU) patients.  Although I have not yet been able to confirm this, it appears that the IMPACT database may no longer be in existence, or perhaps not being added to any more.  Researchers have studied this database and published a number of articles in the medical literature based on it.  Let’s take a look at some interesting data from one such article, based on over 250,000 adult (aged 18 or older) ICU patients who were hospitalized in 138 ICUs during the period 2001-2008.

Notes: All of the following statistics are given in the original source to one decimal place – I’ve rounded them off in this blog post.  The following statistics are based on patients who were admitted for the first time to the ICU during a hospitalization.

Where did they come from?  Source of adult ICU admissions:

• 42 percent from the emergency department
• 32 percent from the surgical suite
• 16 percent from general care floor or step-down unit
•  8 percent from another hospital
•  3 percent from another location

What kind of adult patient is admitted to ICU?

• 66 percent medical
• 22 percent scheduled surgical
• 12 percent unscheduled surgical

Is the ICU a closed model or an open model?

• 75 percent open model with optional or no intensivist consult
• 20 percent open model with mandatory intensivist consult
•   4 percent closed model

Payer mix for adult ICU patients

• 50 percent Medicare
• 30 percent private insurance
•  9 percent self pay
•  9 percent Medicaid
•  3 percent other

Source: Brown, S.E., Ratcliffe, S.J., and others. (2014, Aug.) An empirical comparison of key statistical attributes among potential ICU quality indicators. Critical Care Medicine, 42(8), 1821-1831. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212919/pdf/nihms635834.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org  Note: The link takes you to a free full text “author manuscript,” which is what I used to provide the data noted above.  It was later published in the journal Critical Care Medicine, as noted in the citation.