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Effectiveness of collaboration between emergency department and intensive care unit teams on mortality rates of patients presenting with critical illness: a systematic review.

Abstract

BACKGROUND

The increasing volume of adult patients with critical illness entering emergency departments (EDs) burdens the resources of EDs worldwide. This subpopulation faces a high risk of mortality because they require specialized care which many EDs are not yet poised to deliver. An element crucial to delivering care and decreasing the mortality of critically ill patients in the ED is expert collaborative practice across disciplines. Several ED and intensive care unit (ICU) collaborative models exist including: emergency department intensive care units (EDICU) and medical emergency teams (MET).

OBJECTIVES

To evaluate the effectiveness of collaboration between the ED and ICUs on the mortality rates of critically ill adult ED patients.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Adult ED patients, 18 years and over, with non-surgical critical illness meeting the criteria for ICU admission.

TYPES OF INTERVENTION(S)

Collaboration between the ED and ICU in the management of critically ill patients in the ED.

TYPES OF STUDIES

Observational and descriptive studies.

TYPE OF OUTCOME

All-cause mortality, including 30-day mortality and in-hospital mortality rates at any time period.

SEARCH STRATEGY

The comprehensive literature search included published and unpublished studies in English from the beginning of each database through November 30, 2016. Databases searched included: PubMed, CINAHL, Embase and Cochrane Central Register of Controlled Trials (CENTRAL). A search for gray literature and electronic hand searching of relevant journals was also performed.

METHODOLOGICAL QUALITY

Studies were assessed for methodological quality by four independent reviewers using standardized appraisal tools from the Joanna Briggs Institute (JBI).

DATA EXTRACTION

Data related to the methods, participants, interventions and findings were extracted using a standardized data extraction tool from JBI.

DATA SYNTHESIS

Statistical pooling into a meta-analysis was not possible due to the clinical and methodological heterogeneity in the interventions and outcome measures of the included studies. Results are presented in a narrative form.

RESULTS

Three collaborative models (EDICU, Direct Provider-Provider Collaboration and MET) were identified across five studies. Findings from these studies showed conflicting results. The reviewers were unable to synthesize the evidence to state conclusively the effectiveness of collaborative models on mortality rates of critically ill patients.

CONCLUSIONS

There is limited and conflicting evidence related to the effectiveness of EDICU collaborative models on the mortality rates of critically ill patients preventing the development of practice recommendations. This review underscores the need for more research into the benefits of collaborative models between the ED and ICU.

Authors+Show Affiliations

1Pace University, College of Health Professions, New York, USA 2The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

28902700

Citation

McDowald, Kerchelle, et al. "Effectiveness of Collaboration Between Emergency Department and Intensive Care Unit Teams On Mortality Rates of Patients Presenting With Critical Illness: a Systematic Review." JBI Database of Systematic Reviews and Implementation Reports, vol. 15, no. 9, 2017, pp. 2365-2389.
McDowald K, Direktor S, Hynes EA, et al. Effectiveness of collaboration between emergency department and intensive care unit teams on mortality rates of patients presenting with critical illness: a systematic review. JBI Database System Rev Implement Rep. 2017;15(9):2365-2389.
McDowald, K., Direktor, S., Hynes, E. A., Sahadeo, A., & Rogers, M. E. (2017). Effectiveness of collaboration between emergency department and intensive care unit teams on mortality rates of patients presenting with critical illness: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(9), pp. 2365-2389. doi:10.11124/JBISRIR-2017-003365.
McDowald K, et al. Effectiveness of Collaboration Between Emergency Department and Intensive Care Unit Teams On Mortality Rates of Patients Presenting With Critical Illness: a Systematic Review. JBI Database System Rev Implement Rep. 2017;15(9):2365-2389. PubMed PMID: 28902700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of collaboration between emergency department and intensive care unit teams on mortality rates of patients presenting with critical illness: a systematic review. AU - McDowald,Kerchelle, AU - Direktor,Svetlana, AU - Hynes,Elizabeth A, AU - Sahadeo,Anna, AU - Rogers,Margaret E, PY - 2017/9/14/entrez PY - 2017/9/14/pubmed PY - 2018/6/26/medline SP - 2365 EP - 2389 JF - JBI database of systematic reviews and implementation reports JO - JBI Database System Rev Implement Rep VL - 15 IS - 9 N2 - BACKGROUND: The increasing volume of adult patients with critical illness entering emergency departments (EDs) burdens the resources of EDs worldwide. This subpopulation faces a high risk of mortality because they require specialized care which many EDs are not yet poised to deliver. An element crucial to delivering care and decreasing the mortality of critically ill patients in the ED is expert collaborative practice across disciplines. Several ED and intensive care unit (ICU) collaborative models exist including: emergency department intensive care units (EDICU) and medical emergency teams (MET). OBJECTIVES: To evaluate the effectiveness of collaboration between the ED and ICUs on the mortality rates of critically ill adult ED patients. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adult ED patients, 18 years and over, with non-surgical critical illness meeting the criteria for ICU admission. TYPES OF INTERVENTION(S): Collaboration between the ED and ICU in the management of critically ill patients in the ED. TYPES OF STUDIES: Observational and descriptive studies. TYPE OF OUTCOME: All-cause mortality, including 30-day mortality and in-hospital mortality rates at any time period. SEARCH STRATEGY: The comprehensive literature search included published and unpublished studies in English from the beginning of each database through November 30, 2016. Databases searched included: PubMed, CINAHL, Embase and Cochrane Central Register of Controlled Trials (CENTRAL). A search for gray literature and electronic hand searching of relevant journals was also performed. METHODOLOGICAL QUALITY: Studies were assessed for methodological quality by four independent reviewers using standardized appraisal tools from the Joanna Briggs Institute (JBI). DATA EXTRACTION: Data related to the methods, participants, interventions and findings were extracted using a standardized data extraction tool from JBI. DATA SYNTHESIS: Statistical pooling into a meta-analysis was not possible due to the clinical and methodological heterogeneity in the interventions and outcome measures of the included studies. Results are presented in a narrative form. RESULTS: Three collaborative models (EDICU, Direct Provider-Provider Collaboration and MET) were identified across five studies. Findings from these studies showed conflicting results. The reviewers were unable to synthesize the evidence to state conclusively the effectiveness of collaborative models on mortality rates of critically ill patients. CONCLUSIONS: There is limited and conflicting evidence related to the effectiveness of EDICU collaborative models on the mortality rates of critically ill patients preventing the development of practice recommendations. This review underscores the need for more research into the benefits of collaborative models between the ED and ICU. SN - 2202-4433 UR - https://www.unboundmedicine.com/medline/citation/28902700/Effectiveness_of_collaboration_between_emergency_department_and_intensive_care_unit_teams_on_mortality_rates_of_patients_presenting_with_critical_illness:_a_systematic_review_ L2 - http://Insights.ovid.com/pubmed?pmid=28902700 DB - PRIME DP - Unbound Medicine ER -