Emergency department length of stay and outcomes of emergency department–based intensive care unit patients
Abstract Objective Emergency department (ED) boarding of patients who are critically ill is associated with poor outcomes. ED‐based intensive care units (ED‐ICUs) may mitigate the risks of ED boarding. We sought to analyze the impact of ED length of stay (LOS) before transfer to an ED‐ICU on patient...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-02-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12684 |
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| author | Henrique A. Puls Nathan L. Haas James A. Cranford Richard P. Medlin Jr Benjamin S. Bassin |
| author_facet | Henrique A. Puls Nathan L. Haas James A. Cranford Richard P. Medlin Jr Benjamin S. Bassin |
| author_sort | Henrique A. Puls |
| collection | DOAJ |
| description | Abstract Objective Emergency department (ED) boarding of patients who are critically ill is associated with poor outcomes. ED‐based intensive care units (ED‐ICUs) may mitigate the risks of ED boarding. We sought to analyze the impact of ED length of stay (LOS) before transfer to an ED‐ICU on patient outcomes. Methods We retrospectively analyzed adult ED patients managed in the ED‐ICU at a US medical center. Bivariate and multivariable linear regressions tested ED LOS as a predictor of inpatient ICU and hospital LOS, and separate bivariate and multivariable logistic regressions tested ED LOS as a predictor of inpatient ICU admission, 48‐hour mortality, and hospital mortality. Multivariable analyses’ covariates were age, sex, Charlson Comorbidity Index (CCI), Emergency Severity Index, and eSimplified Acute Physiology Score (eSAPS3). Results We included 5859 ED visits with subsequent care in the ED‐ICU. Median age, CCI, eSAPS3, ED LOS, and ED‐ICU LOS were 62 years (interquartile range [IQR], 48–73 years), 5 (IQR, 2–8), 46 (IQR, 36–56), 3.6 hours (IQR, 2.5–5.3 hours), and 8.5 hours (IQR, 5.3–13.4 hours), respectively, and 46.3% were women. Bivariate analyses showed negative associations of ED LOS with hospital LOS (β = −3.4; 95% confidence interval [CI], −5.9 to −1.0), inpatient ICU admission (odds ratio [OR], 0.86, 95% CI, 0.84–0.88), 48‐hour mortality (OR, 0.89; 95% CI, 0.82–0.98), and hospital mortality (OR, 0.89; 95% CI, 0.85–0.92), but no association with inpatient ICU LOS. Multivariable analyses showed a negative association of ED LOS with inpatient ICU admission (OR, 0.91; 95% CI, 0.88–0.93), but no associations with other outcomes. Conclusions We observed no significant associations between ED LOS before ED‐ICU transfer and worsened outcomes, suggesting an ED‐ICU may mitigate the risks of ED boarding of patients who are critically ill. |
| format | Article |
| id | doaj-art-02e9d851ad03470ebdb05a40d210fee1 |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2022-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-02e9d851ad03470ebdb05a40d210fee12025-08-20T02:54:50ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522022-02-0131n/an/a10.1002/emp2.12684Emergency department length of stay and outcomes of emergency department–based intensive care unit patientsHenrique A. Puls0Nathan L. Haas1James A. Cranford2Richard P. Medlin Jr3Benjamin S. Bassin4Department of Emergency Medicine University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Ann Arbor Michigan USADepartment of Emergency Medicine University of Michigan Ann Arbor Michigan USAAbstract Objective Emergency department (ED) boarding of patients who are critically ill is associated with poor outcomes. ED‐based intensive care units (ED‐ICUs) may mitigate the risks of ED boarding. We sought to analyze the impact of ED length of stay (LOS) before transfer to an ED‐ICU on patient outcomes. Methods We retrospectively analyzed adult ED patients managed in the ED‐ICU at a US medical center. Bivariate and multivariable linear regressions tested ED LOS as a predictor of inpatient ICU and hospital LOS, and separate bivariate and multivariable logistic regressions tested ED LOS as a predictor of inpatient ICU admission, 48‐hour mortality, and hospital mortality. Multivariable analyses’ covariates were age, sex, Charlson Comorbidity Index (CCI), Emergency Severity Index, and eSimplified Acute Physiology Score (eSAPS3). Results We included 5859 ED visits with subsequent care in the ED‐ICU. Median age, CCI, eSAPS3, ED LOS, and ED‐ICU LOS were 62 years (interquartile range [IQR], 48–73 years), 5 (IQR, 2–8), 46 (IQR, 36–56), 3.6 hours (IQR, 2.5–5.3 hours), and 8.5 hours (IQR, 5.3–13.4 hours), respectively, and 46.3% were women. Bivariate analyses showed negative associations of ED LOS with hospital LOS (β = −3.4; 95% confidence interval [CI], −5.9 to −1.0), inpatient ICU admission (odds ratio [OR], 0.86, 95% CI, 0.84–0.88), 48‐hour mortality (OR, 0.89; 95% CI, 0.82–0.98), and hospital mortality (OR, 0.89; 95% CI, 0.85–0.92), but no association with inpatient ICU LOS. Multivariable analyses showed a negative association of ED LOS with inpatient ICU admission (OR, 0.91; 95% CI, 0.88–0.93), but no associations with other outcomes. Conclusions We observed no significant associations between ED LOS before ED‐ICU transfer and worsened outcomes, suggesting an ED‐ICU may mitigate the risks of ED boarding of patients who are critically ill.https://doi.org/10.1002/emp2.12684bed occupancycritical careemergency servicehospitallength of stayorganization and administration |
| spellingShingle | Henrique A. Puls Nathan L. Haas James A. Cranford Richard P. Medlin Jr Benjamin S. Bassin Emergency department length of stay and outcomes of emergency department–based intensive care unit patients Journal of the American College of Emergency Physicians Open bed occupancy critical care emergency service hospital length of stay organization and administration |
| title | Emergency department length of stay and outcomes of emergency department–based intensive care unit patients |
| title_full | Emergency department length of stay and outcomes of emergency department–based intensive care unit patients |
| title_fullStr | Emergency department length of stay and outcomes of emergency department–based intensive care unit patients |
| title_full_unstemmed | Emergency department length of stay and outcomes of emergency department–based intensive care unit patients |
| title_short | Emergency department length of stay and outcomes of emergency department–based intensive care unit patients |
| title_sort | emergency department length of stay and outcomes of emergency department based intensive care unit patients |
| topic | bed occupancy critical care emergency service hospital length of stay organization and administration |
| url | https://doi.org/10.1002/emp2.12684 |
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