Characteristics and outcomes of patients triaged as critically ill in the emergency department of a tertiary care hospital in Bhutan

Abstract

Background In Bhutan, where the Emergency Medical System is forming and evolving, the number of acutely ill patients requiring critical care, both in the emergency departments and intensive care units, is steadily increasing. Given the lack of baseline data and the ever-increasing number of critical care patients, this study was aimed at describing the characteristics and outcomes of patients triaged as critically ill in the emergency department. Methods An observational study was conducted over a yearlong period in the emergency department where all patients triaged as critically ill were approached for inclusion in the study. A case record form was used for the purpose of data collection. Epidata analysis was used for descriptive analysis and SPSS was used for binary logistic regression. Results A total of 657 critically ill patients of all age groups visited the emergency department over the 1-year study period, with adults constituting the majority (81%). The majority (67%) of these patients had a favorable outcome of surviving to discharge. The most common diagnosis among critically ill neonates was neonatal sepsis. Among the critically ill pediatrics and adults, sepsis, respiratory illnesses, and trauma were the most common diagnoses. Intubation followed by mechanical ventilation and blood product transfusion were the most common lifesaving interventions performed on critically ill patients. Conclusion The findings from this study constitute the first ever local database, at the national referral hospital in Bhutan, of critically ill patients treated in the emergency department. It highlights the central role the emergency department plays in their management and provides information for strengthening critical care services. It also highlights the areas of improvement and identifies high yield areas of training for the emergency department.

Epidemiology and outcomes of critically ill patients in the Emergency Department of a tertiary teaching hospital in Rwanda

“…A 2022 systematic review of 50 papers and meta-analysis of 33 papers found that an ED LOS > 24 hours and < 3 hours was associated with mortality among patients admitted to the ICU and non-ICU patients, respectively. (24) However, none of these reviews included studies from African countries.This study showed a median LOS of 31 hours and boarding of 23 hours which is higher than studies in Bhutan (18 hours) and Nepal (6 hours) (11,25). The Bhutan study noted a crude OR of mortality of 1.52 for patients with ED LOS > 6 hours though this was not signi cant (p = 0.082).…”

“…(6) In Bhutan, the most common critical care interventions performed in the ED were intubation (28.3%), CVC insertion (20.7%), and hemodialysis (16.6%) and mortality of critically ill patients was 38.0%. (11) The frequency of critical care interventions at KUTH and the outcomes of patients receiving these interventions has yet to be reported.…”