Table 1.
Hospital practices
| Hospital Practices | Statistics |
|---|---|
| Hospital triage practices | |
| General hospital protocols or criteria to guide the triage of patients from the ED to ICUs, SDUs, or wards; hospitals, n (%) | 19 (73.1) |
| Diagnosis-specific hospital protocols or criteria to guide the triage of patients from the ED to ICUs, SDUs, or wards; hospitals, n (%) | 16 (61.5) |
| ARF including BiPAP | 2 (7.7) |
| Sepsis | 10 (38.5) |
| ICUs | |
| ICUs that routinely admit medical patients, n (%) | |
| 1 ICU | 22 (84.6) |
| >1 ICU | 4 (15.4) |
| ICU beds that routinely admit medical patients, mean (SD) | 24 (12) |
| Hospitals with ICU flex beds that can alternate between different levels of care or that can be used for overflow; hospitals, n (%) | 15 (57.7) |
| ICUs staffed with an intensivist as the primary physician; hospitals, n (%) | 24 (92.3) |
| Most senior bedside clinician in ICU overnight; hospitals, n (%) | |
| Nonintensivist attending physician (e.g., hospitalist) | 19 (73.1) |
| Resident or advanced practice provider | 4 (15.4) |
| Intensivist attending physician | 3 (11.5) |
| Standard of two ICU patients per nurse; hospitals, n (%) | 25 (96.2) |
| ICU telemedicine or other remote monitoring; hospitals, n (%) | 4 (15.4) |
| Wards | |
| Mechanical ventilation permitted for some patients on wards not being imminently transferred to an ICU; hospitals, n (%) | 9 (34.6) |
| Permitted frequency for use of noninvasive ventilation (i.e., CPAP or BiPAP) on the ward; hospitals, n (%) | |
| Any time of day without a time limit | 11 (44.0) |
| Nighttime and during naps | 7 (28.0) |
| Any time of day with time limits | 5 (20.0) |
| Nighttime only | 2 (8.0) |
| Permitted use of high-flow nasal cannula on the ward; hospitals, n (%) | |
| Allowed without limits | 19 (73.1) |
| Allowed, but with limits on flow rate, oxygen concentration, or duration of use | 4 (15.4) |
| Not allowed or not available | 3 (11.5) |
| Emergency departments | |
| Maximum number of patients who can be under treatment in the ED at a given time (excluding patients in fast track, observation, or registered but not yet under treatment); mean patients, n (SD) | 34 (16) |
| Respiratory therapist(s) dedicated to the ED; hospitals, n (%) | 7 (26.9) |
| Standard maximum of four ED patients per nurse; hospitals, n (%) | 20 (83.3) |
| Primary responsibility for determining whether an ED patient will be admitted to the ICU during daytime hours; hospitals, n (%) | |
| ICU physician | 12 (46.2) |
| Collaborative between ICU, ED, and hospitalist physicians | 9 (35.6) |
| Hospitalist | 4 (15.4) |
| ED physician | 1 (3.9) |
| Primary responsibility for determining whether an ED patient will be admitted to the ICU during nighttime hours; hospitals, n (%) | |
| Hospitalist | 17 (65.4) |
| Collaborative between ICU, ED, and hospitalist physicians | 6 (23.1) |
| ICU physician | 2 (7.7) |
| ED physician | 1 (3.9) |
| Primary responsibility for managing patients boarding in the ED once a decision has been made to admit them to an ICU; hospital, n (%) | |
| Inpatient ICU team | 18 (72.0) |
| ED team | 4 (16.0) |
| Joint ED-ICU management | 3 (12.0) |
| Step-down units | |
| SDU available during study period,* hospitals, n (%) | 15 (57.7) |
| SDU can admit patients requiring noninvasive ventilation (i.e., BiPAP) or vasopressors/inotropes; hospitals, n (%) | 13 (100) |
| SDU places time limits on noninvasive ventilation (i.e., BiPAP) or vasopressors/inotropes before requiring ICU admission; hospitals, n (%) | 7 (53.9) |
| Standard of three SDU patients per nurse; hospitals, n (%) | 11 (84.6) |
Definition of abbreviations: ARF = acute respiratory failure; BiPAP = bilevel positive airway pressure; CPAP = continuous positive airway pressure; ED = emergency department; ICU = intensive care unit; SD = standard deviation; SDU = step-down unit.
Notes: Data are reported as complete case responses; total study hospitals = 26; some hospitals did not supply answers to some questions.
*
Two hospitals’ SDUs are no longer open.