Factors related to delayed intensive care unit admission from emergency department-A retrospective cohort study

Etiologies of altered level of consciousness in the emergency room

Altered levels of consciousness (ALCs) is a challenging issue; however, data describing its etiology and frequency are lacking. This study aimed to clarify and classify the etiologies of ALCs in the emergency room (ER) and to evaluate their destinations and the form of discharge. This retrospective study included patients with an ALC who visited the ER of a university hospital between January 2018 and December 2020. The cause and classification of the ALCs were carefully determined by a consortium of board-certified faculty members in emergency medicine, internal medicine, and neurology. The reference point for determining the etiology of ALC was discharge from the ER. In total, 2028 patients with ALCs were investigated. More than half (1037, 51.1%) visited the ER between 9:00 and 18:00. The most common etiology was systemic infection (581, 28.6%), followed by metabolic causes (455, 22.4%), and stroke (271, 13.4%). The two leading etiologies were extracranial and had a majority of the cases (1036, 51.5%). The overall mortality rate was 17.2%. This study provides fundamental information on ALC in the ER. Although intracranial etiologies have been foregrounded, this study demonstrated that extracranial etiologies are the main cause of ALC in the ER.

Association between emergency department length of stay and patient outcomes: A systematic review

In this review, we investigate associations between time spent in the emergency department (ED) and patient reported outcomes. ED staff provide initial assessment, treatment and referral to patients presenting with an acute status to the hospital 24 h a day. ED length of stay, including ED boarding, and treatment received in the ED may affect patient outcomes. In this review we considered published studies that explored the association of ED length of stay of individuals of any age with their subsequent outcomes, including mortality and inpatient length of stay (IPLOS). Joanna Briggs Institute methods for systematic reviews of association were followed. Search strategies were developed to identify studies published in English since 2000 for inclusion. Two reviewers assessed the studies for inclusion and methodological quality and extracted data independently. In total, 34 studies were included in the review, including one case-control, one analytical cross-sectional, and 32 retrospective cohort studies, with a total sample size of 2,308,840 patients. Overall, there were variable associations of time spent in the ED and mortality, IPLOS, time-to-treatment and adverse events. However, findings indicated that older people are at risk for longer ED stays. They may also experience higher mortality. Specific focus should be placed upon elderly people in the ED, to reduce their exposure to the ED environment where possible and to implement focused initiatives that address their specific and complex treatment needs. We conclude that the diversity of individual settings and health systems will require locally defined and relevant solutions to locally identified issues.

Factors contributing to delay intensive care unit admission of critically ill patients from the adult emergency Department in Tikur Anbessa Specialized Hospital

BACKGROUND

The transfer time for critically ill patients from the emergency department (ED) to the Intensive care unit (ICU) must be minimal; however, some factors prolong the transfer time, which may delay intensive care treatment and adversely affect the patient's outcome.

PURPOSE

To identify factors affecting intensive care unit admission of critically ill patients from the emergency department.

PATIENTS AND METHODS

A cross-sectional study design was conducted from January 13 to April 12, 2020, at the emergency department of Tikur Anbesa Specialized Hospital. All critically ill patients who need intensive care unit admission during the study period were included in the study. A pretested structured questionnaire was adapted from similar studies. The data were collected by chart review and observation. Then checked data were entered into Epi-data version 4.1 and cleaned data was exported to SPSS Version 25 for analysis. Descriptive statistics, bivariate and multivariate logistic regression were used to analyze the data.

RESULT

From the total of 102 critically ill patients who need ICU admission 84.3% of them had prolonged lengths of ED stay. The median length of ED stay was 13.5 h with an IQR of 7-25.5 h. The most common reasons for delayed ICU admission were shortage of ICU beds 56 (65.1%) and delays in radiological examination results 13(15.1%). On multivariate logistic regression p < 0.05 male gender (AOR = 0.175, 95% CI: (0.044, 0.693)) and shortage of ICU bed (AOR = 0.022, 95% CI: (0.002, 0.201)) were found to have a significant association with delayed intensive care unit admission.

CONCLUSION

there was a delay in ICU admission of critically ill patients from the ED. Shortage of ICU bed and delay in radiological investigation results were the reasons for the prolonged ED stay.