# Benefits of ICU admission for patients with acute respiratory failure or sepsis: A mixed-methods study across 26 hospitals

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2020 · $743,873

## Abstract

Patients with acute respiratory failure (ARF) and sepsis (the most common and lethal cause of the acute
respiratory distress syndrome) are commonly admitted to intensive care units (ICUs) in the United States even
when they do not require life support. However, ICU admission rates for these patients vary considerably
among hospitals and even within hospitals over time due to bed availability. This practice variability suggests
that some patients may be “under-triaged” to wards when their outcomes could be improved by sending them
directly to the ICU (e.g., due to closer nurse or respiratory therapist monitoring). Other patients may be “over-
triaged” to ICUs when their outcomes and costs of care would be as good or better by sending them directly to
wards (e.g., due to less delirium or immobility). Furthermore, determining which of these “discretionary” ICU
admissions could be treated as well or better on wards would improve timely access to ICUs for patients with
more advanced forms of cardiorespiratory collapse and more obvious indications for ICU admission.
To improve outcomes for patients with ARF and/or sepsis by optimizing their triage, this application proposes a
mixed-methods study of patients admitted through the emergency departments of 26 diverse hospitals in the
Kaiser Permanente Northern California health system and the University of Pennsylvania Health System. Our
primary goals are to determine which patients with ARF and/or sepsis benefit from ICU admission, and which
emergency department, ward, and ICU characteristics and processes of care contribute to such net ICU
benefits. Several methodological innovations will enable us to achieve these goals, and to surmount key
limitations to prior studies that have sought to determine which acutely ill patients benefit from ICU admission.
First, whereas all prior studies used approaches to causal inference that were susceptible to confounding by
unmeasured differences among hospitals, we will obtain unbiased estimates of which patients benefit from ICU
or ward admission by modeling a within-hospital variable – ICU capacity at the time of triage – as an
instrumental variable. Second, although prior studies have been unable to determine exactly which patients the
results apply to, the granular electronic health record data available across our study hospitals will enable our
results to apply directly to well-characterized individual patients, promoting personalized triage decisions.
Third, our use of ethnography and semi-structured interviews in hospitals that obtain large and small net ICU
benefits will identify mechanisms by which different hospitals achieve improved outcomes in ICUs and wards.
Completing the aims of this study will improve public health by identifying ways in which emergency
departments, ICUs, and wards can improve outcomes for the more than 4 million Americans hospitalized each
year with ARF and/or sepsis. Such results will also provide the evidence needed to develop and...

## Key facts

- **NIH application ID:** 9921490
- **Project number:** 5R01HL136719-04
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Scott D Halpern
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $743,873
- **Award type:** 5
- **Project period:** 2017-04-01 → 2022-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9921490

## Citation

> US National Institutes of Health, RePORTER application 9921490, Benefits of ICU admission for patients with acute respiratory failure or sepsis: A mixed-methods study across 26 hospitals (5R01HL136719-04). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/9921490. Licensed CC0.

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