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D'Arcy J, Doherty S, Fletcher L, Neto AS, Jones D. Intensive care unit admission from the emergency department in the setting of National Emergency Access Targets. CRIT CARE RESUSC 2023; 25:84-89. [PMID: 37876604 PMCID: PMC10581270 DOI: 10.1016/j.ccrj.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Purpose Since the introduction of National Emergency Access Targets (NEATs) in 2012 there has been little research examining patients admitted to the intensive care unit (ICU).We assessed differences in baseline characteristics and outcomes of patients admitted from the Emergency Department (ED) to the ICU within 4 hours compared with patients who were not. Methods This retrospective observational study included all adults (≥18 years old) admitted to the ICU from the ED of Austin Hospital, Melbourne, Australia, between 1 January 2017 and 31st December 2019 inclusive. Results 1544 patients were admitted from the ED to the ICU and 65% had an ED length of stay (EDLOS) > 4 hour. Such patients were more likely to be older, female, with less urgent triage category scores and lower illness severity. Sepsis and respiratory admission diagnoses, and winter presentations were significantly more prevalent in this group.After adjustment for confounders, patients with an EDLOS > 4 hours had lower hospital mortality; 8% v 21% (p = 0.029; OR, 1.62), shorter ICU length of stay 2.2 v 2.4 days (p = 0.043), but a longer hospital length of stay 6.2 v 6.8 days (p = < 0.001). Conclusion Almost two thirds of patients breached the NEAT of 4 hours. These patients were more likely to be older, female, admitted in winter with sepsis and respiratory diagnoses, and have lower illness severity and less urgent triage categories. NEAT breach was associated with reduced hospital mortality but an increased hospital length of stay.
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Affiliation(s)
| | | | - Luke Fletcher
- Austin Health, Melbourne, Australia
- Data Analytics Research and Evaluation (DARE) Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Ary Serpa Neto
- Austin Health, Melbourne, Australia
- Data Analytics Research and Evaluation (DARE) Centre, University of Melbourne, Melbourne, VIC, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Daryl Jones
- Austin Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Moon SW, Lee JH, Lee HS, Kim HY, Lee M, Park I, Chung HS, Kim JH. Effects of Emergency Transfer Coordination Center on Length of Stay of Critically Ill Patients in the Emergency Department. West J Emerg Med 2022; 23:846-854. [DOI: 10.5811/westjem.2022.8.56039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/13/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Critically ill patients are frequently transferred from other hospitals to the emergency departments (ED) of tertiary hospitals. Due to the unforeseen transfer, the ED length of stay (LOS) of the patient is likely to be prolonged in addition to other potentially adverse effects. In this study we sought to confirm whether the establishment of an organized unit — the Emergency Transfer Coordination Center (ETCC) — to systematically coordinate emergency transfers would be effective in reducing the ED LOS of transferred, critically ill patients.
Methods: The present study is a retrospective observational study focusing on patients who were transferred from other hospitals and admitted to the intensive care unit (ICU) of the ED in a tertiary hospital located in northwestern Seoul, the capital city of South Korea, from January 2019 – December 2020. The exposure variable of the study was ETCC approval before transfer, and ED LOS was the primary outcome. We used propensity score matching for comparison between the group with ETCC approval and the control group.
Results: Included in the study were 1,097 patients admitted to the ICU after being transferred from other hospitals, of whom 306 (27.9%) were transferred with ETCC approval. The median ED LOS in the ETCC-approved group was significantly reduced to 277 minutes compared to 385 minutes in the group without ETCC approval. The ETCC had a greater effect on reducing evaluation time than boarding time, which was the same for populations with different clinical features.
Conclusion: An ETCC can be effective in systematically reducing the ED LOS of critically ill patients who are transferred from other hospitals to tertiary hospitals that are experiencing severe crowding.
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Affiliation(s)
- Sun Wook Moon
- Yonsei University College of Medicine, Department of Emergency Medicine, Seoul, the Republic of Korea
| | - Ji Hwan Lee
- Yonsei University College of Medicine, Department of Emergency Medicine, Seoul, the Republic of Korea
| | - Hyun Sim Lee
- Yonsei University Health System, Department of Emergency Nursing, Seoul, the Republic of Korea
| | - Ha Yan Kim
- Yonsei University College of Medicine, Department of Biomedical Systems Informatics, Seoul, the Republic of Korea
| | - Myeongjee Lee
- Yonsei University College of Medicine, Department of Biomedical Systems Informatics, Seoul, the Republic of Korea
| | - Incheol Park
- Yonsei University College of Medicine, Department of Emergency Medicine, Seoul, the Republic of Korea
| | - Hyun Soo Chung
- Yonsei University College of Medicine, Department of Emergency Medicine, Seoul, the Republic of Korea
| | - Ji Hoon Kim
- Yonsei University College of Medicine, Department of Emergency Medicine, Seoul, the Republic of Korea; Yonsei University College of Medicine, Department of Preventive Medicine, Seoul, the Republic of Korea
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Stey AM, Kanzaria HK, Dudley RA, Bilimoria KY, Knudson MM, Callcut RA. Emergency Department Length of Stay and Mortality in Critically Injured Patients. J Intensive Care Med 2022; 37:278-287. [PMID: 33641512 DOI: 10.1177/0885066621995426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Multicenter data from 2 decades ago demonstrated that critically ill and injured patients spending more than 6 hours in the emergency department (ED) before transfer to the intensive care unit (ICU) had higher mortality rates. A contemporary analysis of ED length of stay in critically injured patients at American College of Surgeons' Trauma Quality Improvement Program (ACS-TQIP) centers was performed to test whether prolonged ED length of stay is still associated with mortality. METHODS This was an observational cohort study of critically injured patients admitted directly to ICU from the ED in ACS-TQIP centers from 2010-2015. Spending more than 6 hours in the ED was defined as prolonged ED length of stay. Patients with prolonged ED length of stay were matched to those with non-prolonged ED length of stay and mortality was compared. MAIN RESULTS A total of 113,097 patients were directly admitted from the ED to the ICU following injury. The median ED length of stay was 167 minutes. Prolonged ED length of stay occurred in 15,279 (13.5%) of patients. Women accounted for 29.4% of patients with prolonged ED length of stay but only 25.8% of patients with non-prolonged ED length of stay, P < 0.0001. Mortality rates were similar after matching-4.5% among patients with prolonged ED length of stay versus 4.2% among matched controls. Multivariable logistic regression of the matched cohorts demonstrated prolonged ED length of stay was not associated with mortality. However, women had higher adjusted mortality compared to men Odds Ratio = 1.41, 95% Confidence Interval 1.28 -1.61, P < 0.0001. CONCLUSION Prolonged ED length of stay is no longer associated with mortality among critically injured patients. Women are more likely to have prolonged ED length of stay and mortality.
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Affiliation(s)
- Anne M Stey
- Northwestern University Feinberg School of Medicine, IL, Chicago
| | - Hemal K Kanzaria
- University of California San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | | | - Karl Y Bilimoria
- Northwestern University Feinberg School of Medicine, IL, Chicago
| | - M Margaret Knudson
- University of California San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
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Engebretsen S, Bogstrand ST, Jacobsen D, Rimstad R. Quality of care, resource use and patient outcome by use of emergency response team compared with standard care for critically ill medical patients in the emergency department: a retrospective single-centre cohort study from Norway. BMJ Open 2021; 11:e047264. [PMID: 34385247 PMCID: PMC8362729 DOI: 10.1136/bmjopen-2020-047264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The study aimed to investigate quality of care, resource use and patient outcome in management by an emergency response team versus standard care for critically ill medical patients in the emergency department (ED). The emergency response team was multidisciplinary and had eight members, with a registrar in internal medicine as team leader. DESIGN Register-based retrospective cohort study. SETTING Tertiary hospital in Norway. PARTICIPANTS The study included 1120 patients with National Early Warning Score 2 (NEWS2) 5-10 points from 2015 and 2016. Patients missing ≥3 NEWS2 part scores, <18 years and with orders 'Not for ICU' or 'Not for resuscitation' were excluded. OUTCOME MEASURES Quality of care: pain assessment documented, analgesics given within 20 min, complete set of vital signs documented and antibiotics within 60 min if sepsis. Resource use: >3 diagnostic interventions, critical care in the ED and ED length of stay (LOS) <180 min. Patient outcome: intensive care unit (ICU) admission, ICU LOS <66 hours, hospital LOS <194 hours and mortality. RESULTS The median age was 66 years, 53.5% were male, 44.3% were admitted to the ICU and the mortality rate was 10.6%. Altogether 691 patients received team management and 429 standard care. Team management had a positive association with 'complete set of vital signs documented' (OR 1.720, CI 1.254 to 2.360), 'analgesics given within 20 minutes' (OR 3.268, CI 1.375 to 7.767) and 'antibiotics within 60 minutes if sepsis' (OR 7.880, CI 3.322 to 18.691), but a negative association with ' pain assessment documented' (OR 0.068, CI 0.037 to 0.128). Team management was also associated with 'critical care in the ED' (OR 9.900, CI 7.127 to 13.751), 'ED LOS <180 min' (OR 2.944, CI 2.070 to 4.187), 'ICU admission' (OR 2.763, CI 1.962 to 3.891) and 'mortality' (OR 1.882, CI 1.142 to 3.102). CONCLUSIONS Team management showed positive results for quality of care and resource use. The results for later outcomes such as mortality, ICU LOS and hospital LOS were more ambiguous.
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Affiliation(s)
- Stine Engebretsen
- Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Dag Jacobsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Rune Rimstad
- Joint Medical Services, Norwegian Armed Forces, Sessvollmoen, Norway
- Department of Corporate Governance, South-Eastern Norway Regional Health Authority, Hamar, Norway
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Engebretsen S, Bogstrand ST, Jacobsen D, Rimstad R. Characteristics, management and outcome of critically ill general medical patients in the Emergency Department: An observational study. Int Emerg Nurs 2020; 54:100939. [PMID: 33302239 DOI: 10.1016/j.ienj.2020.100939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Critically ill general medical patients are an increasing group in the Emergency Department (ED). This register-based cohort study aimed to examine these patients' characteristics, ED management and outcome, and investigate factors associated with ICU admission. METHODS The study comprised all adult medical triage 1 patients treated by a specialized multidisciplinary team in 2015 and 2016. Univariate and multivariate analysis were used. RESULTS 1294 patients were included. Mean age was 59 years, 56% (n = 725) were male, mean National Early Warning Score 2 (NEWS2) was 7, intensive care unit (ICU) admission was 56.8% (n = 735) and mortality rate was 16.8% (n = 217). Median ED length of stay (LOS) was 1.6 h, 1.2 h if admitted to ICU. The most frequent discharge diagnosis was acute poisoning (24.0%, n = 308). Younger age, male gender, arriving at nighttime weekdays, higher NEWS2 at arrival, critical care interventions or medications in the ED was associated with ICU admission. CONCLUSION More than half of the patients were admitted to ICU, and the mortality rate was 16.8%. A large proportion was diagnosed with acute poisoning. Younger age, higher NEWS and critical care in ED were associated with ICU admission. The short ED LOS suggests that management by a multidisciplinary team is beneficial.
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Affiliation(s)
- Stine Engebretsen
- Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway.
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway.
| | - Dag Jacobsen
- Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318 Oslo, Norway; Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
| | - Rune Rimstad
- Medicine, Health, Patient Safety and Integration, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway.
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Abbadessa MKF. Call to Action: The Need for Best Practices for Boarding the Pediatric Intensive Care Patient in the Emergency Department. J Emerg Nurs 2020; 46:150-153. [PMID: 31983462 DOI: 10.1016/j.jen.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/21/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
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Jeong H, Jung YS, Suh GJ, Kwon WY, Kim KS, Kim T, Shin SM, Kang MW, Lee MS. Emergency physician-based intensive care unit for critically ill patients visiting emergency department. Am J Emerg Med 2019; 38:2277-2282. [PMID: 31785978 DOI: 10.1016/j.ajem.2019.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/11/2019] [Accepted: 09/17/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To provide a prompt and optimal intensive care to critically ill patients visiting our emergency department (ED), we set up and ran a specific type of emergency intensive care unit (EICU) managed by emergency physician (EP) intensivists. We investigated whether this EICU reduced the time interval from ED arrival to ICU transfer (ED-ICU interval) without altering mortality. METHODS This was a retrospective study conducted in a tertiary referral hospital. We collected data from ED patients who were admitted to the EICU (EICU group) and other ICUs including medical, surgical, and cardiopulmonary ICUs (other ICUs group), from August 2014 to July 2017. We compared these two groups with respect to demographic findings, including the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ED-ICU interval, ICU mortality, and hospital mortality. RESULTS Among the 3440 critically ill patients who visited ED, 1815 (52.8%) were admitted to the EICU during the study period. The ED-ICU interval for the EICU group was significantly shorter than that for the other ICUs group by 27.5% (5.0 ± 4.9 vs. 6.9 ± 5.4 h, p < 0.001). In multivariable analysis, the ICU mortality (odds ratio = 1.062, 95% confidence interval 0.862-1.308, p = 0.571) and hospital mortality (odds ratio = 1.093, 95% confidence interval 0.892-1.338, p = 0.391) of the EICU group were not inferior to those of the other ICUs group. CONCLUSIONS The EICU run by EP intensivists reduced the time interval from ED arrival to ICU transfer without altering hospital mortality.
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Affiliation(s)
- Hwain Jeong
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
| | - Yoon Sun Jung
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
| | - Gil Joon Suh
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
| | - Woon Yong Kwon
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
| | - Kyung Su Kim
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Taegyun Kim
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - So Mi Shin
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
| | - Min Woo Kang
- Department of Emergency Medicine, CHA Bundang Medical Center, Gyeonggi-do 13496, Republic of Korea
| | - Min Sung Lee
- Division of Critical Care Medicine, Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
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Abella A, Lobo-Valbuena B, Hómez M, Gordo F. Weekend effect: a great problem with a potential solution. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:278. [PMID: 29149861 PMCID: PMC5693558 DOI: 10.1186/s13054-017-1864-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/19/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Ana Abella
- Intensive Care Unit, Hospital Universitario del Henares, Avenida María de Curie s/n. 28822, Coslada, Madrid, Spain
| | - Beatriz Lobo-Valbuena
- Intensive Care Unit, Hospital Universitario del Henares, Avenida María de Curie s/n. 28822, Coslada, Madrid, Spain.
| | - Marcela Hómez
- Intensive Care Unit, Hospital Universitario del Henares, Avenida María de Curie s/n. 28822, Coslada, Madrid, Spain
| | - Federico Gordo
- Intensive Care Unit, Hospital Universitario del Henares, Avenida María de Curie s/n. 28822, Coslada, Madrid, Spain.,Universidad Francisco de Vitoria, Facultad Ciencias de la Salud, Edificio E, Ctra. M-515 Pozuelo-Majadahonda, Madrid, Spain
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Durie ML, Darvall JN. Response to 'Code ICU - A great opportunity for patients and critical care management'. J Crit Care 2017; 42:341. [PMID: 28893441 DOI: 10.1016/j.jcrc.2017.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Matthew L Durie
- Intensive Care Unit, Royal Melbourne Hospital, Grattan St, Parkville, Melbourne, Victoria, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Grattan St, Parkville, Melbourne, Victoria, Australia.
| | - Jai N Darvall
- Intensive Care Unit, Royal Melbourne Hospital, Grattan St, Parkville, Melbourne, Victoria, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Grattan St, Parkville, Melbourne, Victoria, Australia.
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