Impact of triage-to-admission time on patient outcome in European intensive care units: A prospective, multi-national study

Stohl, Sheldon; Sprung, Charles L.; Lippert, Anne; Pirracchio, Romain; Artigas, Antonio; Iapichino, G.; Harris, Steve; Pezzi, Annalisa; Schlesinger, Malka

doi:10.1016/j.jcrc.2019.05.013

Cited by 8 publications

(17 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Whilst it is intuitive that more rapid admission from wards to critical care following a high NEWS trigger will be beneficial, this is the first study to our knowledge to demonstrate this. The previous literature has either focused on patients in the ED [ 15 , 16 , 21 ], or has used the time of decision to admit [ 15 , 18 , 20 ]. Focussing solely on the efferent pathway ignores an important process of detection, escalation, response, and decision.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…A number of studies have demonstrated that timely critical care outreach team (CCOT) response [ 14 ] and prompt admission to critical care [ 15 – 17 ] are associated with improvements in patient outcome whilst other studies have failed to show this relationship [ 18 , 19 ]. There has been an imperfect definition of ‘time zero’, with studies commonly using the time of decision to admit (DTA) to critical care [ 15 , 18 , 20 ] rather than the onset of physiological deterioration and several studies have focused solely on the Emergency Department (ED) [ 15 , 16 , 21 ]. Furthermore, there are multiple confounders that may influence both time to admission and patient outcomes, including critical care capacity [ 17 , 20 ], chronic health and frailty [ 22 ], surgical versus medical status [ 19 ], and acute sickness severity [ 13 , 18 ] and these may account for the heterogeneity in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…There has been an imperfect definition of ‘time zero’, with studies commonly using the time of decision to admit (DTA) to critical care [ 15 , 18 , 20 ] rather than the onset of physiological deterioration and several studies have focused solely on the Emergency Department (ED) [ 15 , 16 , 21 ]. Furthermore, there are multiple confounders that may influence both time to admission and patient outcomes, including critical care capacity [ 17 , 20 ], chronic health and frailty [ 22 ], surgical versus medical status [ 19 ], and acute sickness severity [ 13 , 18 ] and these may account for the heterogeneity in the literature. Adjustment for differences in patient characteristics significantly alter the apparent relationship between timeliness and outcome [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Increased time from physiological derangement to critical care admission associates with mortality

et al. 2021

View full text Add to dashboard Cite

Background Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using ‘decision to admit’ to critical care, or arrival in the emergency department as ‘time zero’, rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission [‘Score to Door’ (STD) time] impacts on patient outcomes. Methods A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. Results Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0–1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0–1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. Conclusion In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the ‘Score to Door’ concept as a clinical indicator within rapid response systems.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Increased time from physiological derangement to critical care admission associates with mortality

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Similar to AEs, the reason for the overwhelmingly high public proportion seems to be the low profitability of ICU beds, characterized by high costs involving both personnel and equipment [15]. It is difficult to compare the supply of ICU beds between different countries [16]. Since the demand for ICUs is greatly affected by the organization of the other hospital services, such as the high-dependency beds as an interim facility, the density of ICU beds can vary a lot from one country to another, and an international standard is difficult to establish [17].…”

Section: Intensive Care Unitsmentioning

confidence: 99%