Among-hospital variation in the association between ICU admission and hospital mortality in patients with ARF. In pooled analyses, ED patients with ARF experienced an OR of 0.75 for in-hospital mortality if admitted initially to the ICU compared with the ward, but across the 27 study hospitals, this effect varied from an OR of 0.08 (95% CI, 0.01–0.56; P < 0.007) to 8.89 (95% CI, 1.60–79.85; P = 0.016). The vertical black line displays no change in mortality (OR = 1), and the vertical red line displays the pooled point estimate of OR 0.75. Horizontal black bars represent 95% CIs. *Upper bound extends beyond figure range; see Table E5 for complete CIs. ARF = acute respiratory failure; CI = confidence interval; ED = emergency department; ICU = intensive care unit; OR = odds ratio.