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Direct and delayed admission to an intensive care or high dependency unit following discharge from the emergency department: associated patient characteristics and hospital outcomes.
Crit Care Resusc. 2012 Sep; 14(3):191-7.CC

Abstract

OBJECTIVE

To compare patients admitted from the emergency department (ED) directly to a ward (EDWard), the intensive care unit (EDICU) or stepdown (high dependency) unit (EDSDU) with patients admitted via the ED, but whose admission to an ICU (EDWardICU) or SDU (EDWardSDU) was preceded by a ward stay.

DESIGN, SETTING AND PARTICIPANTS

Administrative and clinical data linkage; 650-bed, tertiary referral hospital, whose ED has about 60 000 patient presentations per annum; adult patients admitted via the ED to a ward, ICU or SDU and whose ED length of stay (LOS) was < 24 h.

MAIN OUTCOME MEASURE

Hospital outcome and stay.

RESULTS

From January 2004 to December 2007, there were 43 484 patients, of whom 40 609 (93.4%) were EDWard, 1020 (2.3%) were EDICU, 873 (2.0%) were EDSDU, 503 (1.2%) were EDWardSDU, and 479 (1.1%) were EDWardICU. Hospital mortality for EDWardICU patients exceeded that of EDICU patients (34.9% v 23.3%; P < 0.01), as did EDWardSDU exceed EDSDU (12.3% v 7.8%; P < 0.01). Median ward stay for EDWardICU patients was 47 h 37 min (IQR, 14 h 48 min - 131 h 53 min) and for EDWardSDU patients, 46 h 18min (IQR, 18h 28 min - 140h 12 min) (P=0.75). Compared with patients admitted to the ICU from the operating theatre, EDWardICU patients had a longer median ward stay (58 h 35 min v 34 h 36 min; P = 0.03) and hospital mortality (42.8% v 20.2%; P < 0.01).

CONCLUSION

Patients discharged from the ED to a general ward and subsequently to an ICU or SDU had a mortality that exceeded that of ED patients admitted directly to the ICU or SDU. Further investigations are warranted to explain this excess mortality and ascertain the extent of potential preventability.

Authors+Show Affiliations

Royal Adelaide Hospital, Adelaide, SA, Australia. Arthas.Flabouris@health.sa.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22963213

Citation

Flabouris, Arthas, et al. "Direct and Delayed Admission to an Intensive Care or High Dependency Unit Following Discharge From the Emergency Department: Associated Patient Characteristics and Hospital Outcomes." Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, vol. 14, no. 3, 2012, pp. 191-7.
Flabouris A, Jeyadoss J, Field J, et al. Direct and delayed admission to an intensive care or high dependency unit following discharge from the emergency department: associated patient characteristics and hospital outcomes. Crit Care Resusc. 2012;14(3):191-7.
Flabouris, A., Jeyadoss, J., Field, J., & Soulsby, T. (2012). Direct and delayed admission to an intensive care or high dependency unit following discharge from the emergency department: associated patient characteristics and hospital outcomes. Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine, 14(3), 191-7.
Flabouris A, et al. Direct and Delayed Admission to an Intensive Care or High Dependency Unit Following Discharge From the Emergency Department: Associated Patient Characteristics and Hospital Outcomes. Crit Care Resusc. 2012;14(3):191-7. PubMed PMID: 22963213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct and delayed admission to an intensive care or high dependency unit following discharge from the emergency department: associated patient characteristics and hospital outcomes. AU - Flabouris,Arthas, AU - Jeyadoss,Jellsingh, AU - Field,John, AU - Soulsby,Tom, PY - 2012/9/12/entrez PY - 2012/9/12/pubmed PY - 2012/11/2/medline SP - 191 EP - 7 JF - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine JO - Crit Care Resusc VL - 14 IS - 3 N2 - OBJECTIVE: To compare patients admitted from the emergency department (ED) directly to a ward (EDWard), the intensive care unit (EDICU) or stepdown (high dependency) unit (EDSDU) with patients admitted via the ED, but whose admission to an ICU (EDWardICU) or SDU (EDWardSDU) was preceded by a ward stay. DESIGN, SETTING AND PARTICIPANTS: Administrative and clinical data linkage; 650-bed, tertiary referral hospital, whose ED has about 60 000 patient presentations per annum; adult patients admitted via the ED to a ward, ICU or SDU and whose ED length of stay (LOS) was < 24 h. MAIN OUTCOME MEASURE: Hospital outcome and stay. RESULTS: From January 2004 to December 2007, there were 43 484 patients, of whom 40 609 (93.4%) were EDWard, 1020 (2.3%) were EDICU, 873 (2.0%) were EDSDU, 503 (1.2%) were EDWardSDU, and 479 (1.1%) were EDWardICU. Hospital mortality for EDWardICU patients exceeded that of EDICU patients (34.9% v 23.3%; P < 0.01), as did EDWardSDU exceed EDSDU (12.3% v 7.8%; P < 0.01). Median ward stay for EDWardICU patients was 47 h 37 min (IQR, 14 h 48 min - 131 h 53 min) and for EDWardSDU patients, 46 h 18min (IQR, 18h 28 min - 140h 12 min) (P=0.75). Compared with patients admitted to the ICU from the operating theatre, EDWardICU patients had a longer median ward stay (58 h 35 min v 34 h 36 min; P = 0.03) and hospital mortality (42.8% v 20.2%; P < 0.01). CONCLUSION: Patients discharged from the ED to a general ward and subsequently to an ICU or SDU had a mortality that exceeded that of ED patients admitted directly to the ICU or SDU. Further investigations are warranted to explain this excess mortality and ascertain the extent of potential preventability. SN - 1441-2772 UR - https://www.unboundmedicine.com/medline/citation/22963213/Direct_and_delayed_admission_to_an_intensive_care_or_high_dependency_unit_following_discharge_from_the_emergency_department:_associated_patient_characteristics_and_hospital_outcomes_ L2 - https://antibodies.cancer.gov/detail/CPTC-AKR1C1-1 DB - PRIME DP - Unbound Medicine ER -