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Huang KW, Yin CH, Chang R, Chen JS, Chen YS. Price for waiting: the adverse outcomes of boarding critically ill elderly medical patients in the emergency department. Postgrad Med J 2024; 100:391-398. [PMID: 38308652 DOI: 10.1093/postmj/qgae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 12/12/2024] [Accepted: 12/28/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Boarding, the period in which a patient spends in the emergency department (ED) before admission, may be hazardous to critically ill patients, particularly the elderly. This study investigated the associations of boarding with hospital course, prognosis, and medical expenditure in older patients. METHODS From January 2019 to December 2021, the medical records of older patients (age ≥ 65) visiting the ED of a tertiary referral hospital who were admitted to the medical intensive care unit (ICU) were retrospectively reviewed. Eligible patients were categorized into two groups according to boarding time with a cutoff set at 6 h. Primary outcomes were in-hospital mortality, ICU/hospital length of stay, and total/average hospitalization cost. Subgroup analyses considered age and disease type. RESULTS Among 1318 ICU admissions from the ED, 36% were subjected to boarding for over 6 h. Prolonged boarding had a longer ICU (8.9 ± 8.8 vs. 11.2 ± 12.2 days, P < .001) and hospital (17.8 ± 20.1 vs. 22.8 ± 23.0 days, P < .001) stay, higher treatment cost (10.4 ± 13.9 vs. 13.2 ± 16.5 thousands of USD, P = .001), and hospital mortality (19% vs. 25% P = .020). Multivariate regression analysis showed a longer ICU stay in patients aged 65-79 (8.3 ± 8.4 vs. 11.8 ± 14.2 days, P < .001) and cardiology patients (6.9 ± 8.4 vs. 8.8 ± 9.7 days, P = .001). Besides, the treatment cost was also higher for both groups (10.4 ± 14.6 vs. 13.7 ± 17.7 thousands of USD, P = .004 and 8.4 ± 14.0 vs. 11.7 ± 16.6 thousands of USD, P < .001, respectively). CONCLUSION Extended ED boarding for critically ill medical patients over 65 years old was associated with negative outcomes, including longer ICU/hospital stays, higher treatment costs, and hospital mortality.
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Affiliation(s)
- Kuang-Wen Huang
- Department of Emergency Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City 802301, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Chun-Hao Yin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
- Department of Health Care Management, National Sun Yat-sen University, Kaohsiung City 804201, Taiwan
- Department of Nursing, Meiho University, Pingtung County 912009, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
- Department of Recreation and Sports Management, Tajen University, Pingtung County 907101, Taiwan
| | - Jin-Shuen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Yao-Shen Chen
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
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Costa G, Fransvea P, Puccioni C, Giovinazzo F, Carannante F, Bianco G, Catamero A, Masciana G, Miacci V, Caricato M, Capolupo GT, Sganga G. Gastro-intestinal emergency surgery: Evaluation of morbidity and mortality. Protocol of a prospective, multicenter study in Italy for evaluating the burden of abdominal emergency surgery in different age groups. (The GESEMM study). Front Surg 2022; 9:927044. [PMID: 36189400 PMCID: PMC9524583 DOI: 10.3389/fsurg.2022.927044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022] Open
Abstract
Gastrointestinal emergencies (GE) are frequently encountered in emergency department (ED), and patients can present with wide-ranging symptoms. more than 3 million patients admitted to US hospitals each year for EGS diagnoses, more than the sum of all new cancer diagnoses. In addition to the complexity of the urgent surgical patient (often suffering from multiple co-morbidities), there is the unpredictability and the severity of the event. In the light of this, these patients need a rapid decision-making process that allows a correct diagnosis and an adequate and timely treatment. The primary endpoint of this Italian nationwide study is to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18. Secondary endpoints will be to evaluate to analyze the prognostic role of existing risk-scores to define the most suitable scoring system for gastro-intestinal surgical emergency. The primary outcomes are 30-day overall postoperative morbidity and mortality rates. Secondary outcomes are 30-day postoperative morbidity and mortality rates, stratified for each procedure or cause of intervention, length of hospital stay, admission and length of stay in ICU, and place of discharge (home or rehabilitation or care facility). In conclusion, to improve the level of care that should be reserved for these patients, we aim to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18, to analyze the prognostic role of existing risk-scores and to define new tools suitable for EGS. This process could ameliorate outcomes and avoid futile treatments. These results may potentially influence the survival of many high-risk EGS procedure.
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Affiliation(s)
- Gianluca Costa
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Caterina Puccioni
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Giovinazzo
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Carannante
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Gianfranco Bianco
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Alberto Catamero
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Gianluca Masciana
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Valentina Miacci
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Marco Caricato
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Gabriella Teresa Capolupo
- Surgery Centre, Colorectal Surgery Unit, Fondazione Policlinico Universitariio Campus Bio-Medico, Università Campus Bio-Medico, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Catholic University of Sacred Heart, Rome, Italy
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