Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients*

Mathews, Kusum S.; Durst, Matthew S; Vargas-Torres, Carmen; Olson, Ashley; Mazumdar, Madhu; Richardson, Lynne D.

doi:10.1097/ccm.0000000000002993

Cited by 97 publications

(71 citation statements)

References 49 publications

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“…Other common diseases may require critical care in the ED prior to admission, including diabetic ketoacidosis, metabolic derrangements, gastrointestinal hemorrhage, and neurovascular disorders. Unfortunately, the boarding of critically ill patients in the ED is associated with delays in care, which impact broad clinical outcomes in the critically ill 16‐20 …”

Section: Resultsmentioning

confidence: 99%

“…This lack of standardization precludes meaningful aggregation of data or comparisons between published results. Some studies describe boarding as total time spent in the ED 18,20‐26 , with some defining that time only after the decision to admit 18,20,26 . One study required that ICU beds be unavailable for ED boarding to occur, 27 whereas another used the distribution of ED wait times to define outliers 28 .…”

Section: Resultsmentioning

confidence: 99%

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Boarding of critically Ill patients in the emergency department

et al. 2020

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Objectives Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes. Data sources and study selection Review article. Data extraction and data synthesis Emergency department–based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department‐based interventions, hospital‐based interventions, and emergency department–based resuscitation care units. Conclusions Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department–based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Boarding of critically Ill patients in the emergency department

et al. 2020

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“…Earlier studies have shown that each hour of delay independently associates with increased risk of ICU mortality and that delays of 4‐6 hours increase mortality . One recent study showed that in addition to increased mortality, longer stay at the ED is associated with more persistent organ dysfunction . However, there are also other studies with no effect on outcome .…”

Section: Discussionmentioning

confidence: 99%

“…A 3‐hour cutoff value for delayed ICU admission has been used in an earlier study investigating the effect of delayed ICU admission on outcome . The effect of delayed admission on patient outcome has been controversial with either no association in critically ill patients or with worse patient outcome …”

Section: Introductionmentioning

confidence: 99%

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

Aitavaara-Anttila

Liisanantti

Raatiniemi

et al. 2019

Acta Anaesthesiol Scand

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Background:The delays in transferring patients from emergency department (ED) to intensive care unit (ICU) are known to be linked with several adverse events, including prolonged ICU stay and increased hospital mortality. The factors associated with delayed ICU admission include shortage of ICU beds, organizational factors, ED overcrowding, and patient-related factors, including sepsis as admission diagnosis. The aim of this study was to examine ED-related factors associated with prolonged ED stay. Methods: The study population consisted of adult patients admitted (n = 479) from ED to ICU between 31 May 2016 and 19 March 2017 in Oulu University Hospital. A patient's ED length of stay (LOS) exceeding 180 minutes was considered delayed. Results: Most of the patients (380, 79.3%) were admitted to the ICU within 3 hours of hospital admission. In a logistic regression analysis, odds ratios (ORs) for ED LOS > 180 minutes were as follows: for Glasgow Coma Scale score > 9, 2.73(1.39-5.32); for thrombocytes < 100 × 10 9 /mmol, 6.69 (2.32-19.26); for absence of pre-arrival notification, 5.27 (3.04-9.14); and for radiological examination, 3.95(1.72-9.10). Trauma and intoxicated patients had shorter ED LOS while patients with medical conditions had more often prolonged admissions. Conclusion:The delays in ICU admissions were linked to therapeutic and diagnostic procedures and absence of pre-arrival notification. Patients were admitted to the ICU on the basis of diagnosis instead of clinical risk. However, the delays were not associated with worsening outcome, which indicates that sufficient care can be provided at the ED while the ICU admission is pending.

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“…Because hospitals are increasingly burdened with crowding, boarding of critically ill patients in the ED has become increasingly common. 1,2 Studies have shown that prolonged boarding of critically ill patients in the ED is associated with increased morbidity and mortality. 1,2 Moreover, among intubated patients, there is increasing recognition that the management of nonventilator components influences patient outcomes.…”

Section: Commentarymentioning

confidence: 99%