The advanced life support technology which can be provided in the ICU is intended to provide temporary physiologic support for patients with potentially reversible organ failure or dysfunction. In general, only patients who have a reasonable prospect of recovery should be treated in the ICU. The current guidelines of the Society of Critical Care Medicine state that “in general ICU’s should be reserved for those patients with reversible medical conditions who have a reasonable prospect of substantial recovery.” [1] The merits of each potential ICU admission should be assessed on an individual basis, and taking the following factors into account:

When the reversibility and prognosis of a patient’s condition is uncertain, a “time-limited therapeutic trial” in the ICU may be justified. A DNR order does not preclude a patient from being admitted to the ICU; this is a specific instruction not to perform advanced cardiac life support (ACLS) once the patient’s heart has stopped (i.e. once the patient has died). Patients with advanced chronic disease, patients with terminal illnesses, and patients who have suffered a catastrophic insult should only be admitted to the ICU if there is a reasonable chance that the patient may benefit from aggressive management in the ICU and the patient or surrogate is prepared to accept the burden (i.e. pain, suffering) that such therapy may incur. It should be appreciated that death is the only certainty of life, and that the ICU is not a halfway station between life on earth and the hereafter; this implies that not all dying patients need to (or will benefit from) admission to an ICU.

Once a patient is admitted to the ICU the appropriateness of continuing care in the ICU should be evaluated in an ongoing fashion; the fact that aggressive life supportive therapy has been provided to a patient does not imply that it cannot be withdrawn. Patients should only remain in the ICU as long as they continue to derive benefit from the physiological support provided in the ICU. When all the ICU beds are filled the ICU/Critical Care Director or his designee will have the responsibility to admit/discharge patients from these units. Triage decisions should be made explicitly, fairly and justly. Ethnic origin, race, sex, social status, sexual preference or financial status should not be considered in triage decisions. Triage decisions may be made without patient, surrogate or attending physician consent.

In evaluating the appropriateness of an admission to the ICU, the priority of the admission should be determined as well as the disease specific or physiologic indications for admission (as outlined below).

This system defines those patients that will benefit most (Priority 1) to those that will not benefit at all (priority 4) from admission to an ICU.