A national shortage of critical-care physicians and beds means difficult decisions for health care professionals: how to determine which of the sickest patients are most in need of access to the intensive care unit.

What if patients' electronic health records could help a physician determine ICU admission by calculating which patient had the highest risk of death?

Emerging health technologies, including reliable methods to rate the severity of a patient's condition, might provide powerful tools to use scarce and costly health resources efficiently, says a team of University of Michigan Health System researchers in theNew England Journal of Medicine.

"Electronic health records ... are untapped tools that may help us efficiently use valuable critical care resources," says hospitalist and lead author Dr. Lena M. Chen, assistant professor in internal medicine at the University of Michigan.

The study finds that patients' severity of illness isn't always associated with their likelihood of being admitted to the ICU, challenging the notion that limited critical care is reserved for the sickest patients.

ICU admissions for noncardiac patients closely reflected severity of illness (sicker patients were more likely to go to the ICU), but ICU admissions for cardiac patients did not, the study found. While the reasons for this are unclear, authors note that the ICU's explicit role is to provide care for the sickest patients, not to respond to temporary staffing issues or unavailable recovery rooms.

A few integrated health care systems such as the Veterans Affairs Healthcare System and Kaiser Permanente Northern California already have tapped into the ability of electronic health records to generate estimates of the risk of dying within 30 days for patients on admission.