Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department
Abstract Background Boarding of critically ill patients in the emergency department (ED) is an emerging problem that increases mortality. We have developed a “CREM Unit (critical emergency medicine unit)” led by an anesthetist-intensivist who manages critical patients directly in the ED. This study...
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BMC
2025-07-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
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| Online Access: | https://doi.org/10.1186/s44158-025-00262-x |
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| author | Felice Urso Daniele Catalano Ileana Suprina Petrovic Enrico Boero Paola Berchialla Luigi Vetrugno Daniela Silengo |
| author_facet | Felice Urso Daniele Catalano Ileana Suprina Petrovic Enrico Boero Paola Berchialla Luigi Vetrugno Daniela Silengo |
| author_sort | Felice Urso |
| collection | DOAJ |
| description | Abstract Background Boarding of critically ill patients in the emergency department (ED) is an emerging problem that increases mortality. We have developed a “CREM Unit (critical emergency medicine unit)” led by an anesthetist-intensivist who manages critical patients directly in the ED. This study aims to assess whether the CREM Unit is an effective model for mitigating the boarding of critical patients in the ED and the impact of this on mortality. Method This is a retrospective observational study. We collected all patients assigned to the CREM Unit from January 1, 2019, to December 31, 2021. As our primary endpoints, we calculated ED boarding rate and the impact of boarding time on mortality. As a secondary endpoint, we compared observed 28-day mortality to Simplified Acute Physiology Score (SAPS II) predicted mortality. Results Patients managed by the CREM unit were 127 in 2019, 181 in 2020, and 206 in 2021, with a clear upward trend, for a total of 514 patients (p < 0.001). Overall boarding rate was 13.9%, and length of stay in ED was not associated with an increased mortality (p = 0.399). Observed mortality was compared with expected mortality, estimated from the SAPS II score for a group of inpatients (n = 295). Moreover, the median value of SAPS II for inpatients was 54 (40.5–69.0), with an expected mortality of 55.3%, while the observed mortality was 36.8% (95% CI 31.9% to 42.1%, p < 0.0001). Conclusions Over the years, the number of patients assigned to the CREM Unit has grown steadily. These data suggest that the CREM Unit cares for a significant number of critically ill patients and could have a well-defined role both in keeping their boarding low and may contribute to reducing its impact on mortality. |
| format | Article |
| id | doaj-art-d803ce79a90f45028c1db65d18c5cfca |
| institution | DOAJ |
| issn | 2731-3786 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj-art-d803ce79a90f45028c1db65d18c5cfca2025-08-20T03:06:31ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862025-07-015111210.1186/s44158-025-00262-xCritical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency departmentFelice Urso0Daniele Catalano1Ileana Suprina Petrovic2Enrico Boero3Paola Berchialla4Luigi Vetrugno5Daniela Silengo6Anesthesia and Intensive Care Unit, Ospedale San Giovanni BoscoAnesthesia and Intensive Care Unit, Ospedale San Giovanni BoscoAnesthesia and Intensive Care Unit, Ospedale San Giovanni BoscoAnesthesia and Intensive Care Unit, Ospedale San Giovanni BoscoDepartment of Clinical and Biological Sciences, University of TurinDepartment of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata HospitalAnesthesia and Intensive Care Unit, Ospedale San Giovanni BoscoAbstract Background Boarding of critically ill patients in the emergency department (ED) is an emerging problem that increases mortality. We have developed a “CREM Unit (critical emergency medicine unit)” led by an anesthetist-intensivist who manages critical patients directly in the ED. This study aims to assess whether the CREM Unit is an effective model for mitigating the boarding of critical patients in the ED and the impact of this on mortality. Method This is a retrospective observational study. We collected all patients assigned to the CREM Unit from January 1, 2019, to December 31, 2021. As our primary endpoints, we calculated ED boarding rate and the impact of boarding time on mortality. As a secondary endpoint, we compared observed 28-day mortality to Simplified Acute Physiology Score (SAPS II) predicted mortality. Results Patients managed by the CREM unit were 127 in 2019, 181 in 2020, and 206 in 2021, with a clear upward trend, for a total of 514 patients (p < 0.001). Overall boarding rate was 13.9%, and length of stay in ED was not associated with an increased mortality (p = 0.399). Observed mortality was compared with expected mortality, estimated from the SAPS II score for a group of inpatients (n = 295). Moreover, the median value of SAPS II for inpatients was 54 (40.5–69.0), with an expected mortality of 55.3%, while the observed mortality was 36.8% (95% CI 31.9% to 42.1%, p < 0.0001). Conclusions Over the years, the number of patients assigned to the CREM Unit has grown steadily. These data suggest that the CREM Unit cares for a significant number of critically ill patients and could have a well-defined role both in keeping their boarding low and may contribute to reducing its impact on mortality.https://doi.org/10.1186/s44158-025-00262-xCritical careEmergency medicineAnesthesiologyHospital mortalityLengths of stayEmergency service |
| spellingShingle | Felice Urso Daniele Catalano Ileana Suprina Petrovic Enrico Boero Paola Berchialla Luigi Vetrugno Daniela Silengo Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department Journal of Anesthesia, Analgesia and Critical Care Critical care Emergency medicine Anesthesiology Hospital mortality Lengths of stay Emergency service |
| title | Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department |
| title_full | Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department |
| title_fullStr | Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department |
| title_full_unstemmed | Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department |
| title_short | Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department |
| title_sort | critical emergency medicine unit a new model to mitigate critically ill patient boarding in emergency department |
| topic | Critical care Emergency medicine Anesthesiology Hospital mortality Lengths of stay Emergency service |
| url | https://doi.org/10.1186/s44158-025-00262-x |
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