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Effect of an emergency department intensive care unit on medical intensive unit admissions and care: A retrospective cohort study.
Am J Emerg Med. 2021 08; 46:27-33.AJ

Abstract

OBJECTIVE

Evaluate the impact of an emergency critical care center (EC3) on the admissions of critically ill patients to a critical care medicine unit (CCMU) and their outcomes.

METHODS

This was a retrospective before/after cohort study in a tertiary university teaching hospital. To improve the care of critically ill patients in the emergency department (ED), a 9-bed EC3 was opened in the ED in February 2015. All critically ill patients in the emergency department must receive intensive support in EC3 before being considered for admission to the CCMU for further treatment. Patients from the emergency department account for a significant proportion of the patients admitted to the CCMU. The proportions of patients admitted to the CCMU from the ED were analyzed 1 year before and 1 year after the opening of the EC3. We also compared the admission data, demographic data, APACHE III scores and patient outcomes among patients admitted from ED to the CCMU in the year before and the year after the opening of the EC3.

RESULT

The establishment of the EC3 was associated with a decreased proportion of patients admitted to the CCMU from the ED (OR 0.73 95% CI 0.63-0.84, p < 0.01), a decrease in the proportion of patients with sepsis admitted from the ED (OR 0.68, 95% CI, 0.54-0.87, p < 0.01) and a decrease in the proportion of patients with gastrointestinal bleeding admitted from the ED (OR 0.49, 95% CI 0.28-0.84, p < 0.05). Following the establishment of the EC3, patients admitted to the CCMU had a higher APACHE III score in 2015 (74.85 ± 30.42 vs 72.39 ± 29.64, p = 0.015). Fewer low-risk patients were admitted to the CCMU for monitoring following the opening of the EC3 (112 [6.8%] vs. 181 [9.3%], p < 0.01). Propensity score matching analysis showed that the opening of the EC3 was associated with improved 60-day survival (HR 0.84, 95% CI 0.70-0.99, p = 0.046).

CONCLUSION

Following the opening of the EC3, the proportion of CCMU admissions from the ED decreased. The EC3 may be most effective at reducing the admission of lower-acuity patients with GI bleeding and possibly sepsis. The EC3 may be associated with improved survival in ED patients.

Authors+Show Affiliations

Pulmonary and Critical Care Department, The University of Michigan Health System, MI, USA; Shanghai General Hospital of Shanghai Jiaotong University, Shanghai, China.Emergency Department, The University of Michigan Health System, MI, USA.Pulmonary and Critical Care Department, The University of Michigan Health System, MI, USA.Pulmonary and Critical Care Department, The University of Michigan Health System, MI, USA.Pulmonary and Critical Care Department, The University of Michigan Health System, MI, USA. Electronic address: rhyzy@umich.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33714051

Citation

Du, Jiang, et al. "Effect of an Emergency Department Intensive Care Unit On Medical Intensive Unit Admissions and Care: a Retrospective Cohort Study." The American Journal of Emergency Medicine, vol. 46, 2021, pp. 27-33.
Du J, Gunnerson KJ, Bassin BS, et al. Effect of an emergency department intensive care unit on medical intensive unit admissions and care: A retrospective cohort study. Am J Emerg Med. 2021;46:27-33.
Du, J., Gunnerson, K. J., Bassin, B. S., Meldrum, C., & Hyzy, R. C. (2021). Effect of an emergency department intensive care unit on medical intensive unit admissions and care: A retrospective cohort study. The American Journal of Emergency Medicine, 46, 27-33. https://doi.org/10.1016/j.ajem.2021.02.037
Du J, et al. Effect of an Emergency Department Intensive Care Unit On Medical Intensive Unit Admissions and Care: a Retrospective Cohort Study. Am J Emerg Med. 2021;46:27-33. PubMed PMID: 33714051.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of an emergency department intensive care unit on medical intensive unit admissions and care: A retrospective cohort study. AU - Du,Jiang, AU - Gunnerson,Kyle J, AU - Bassin,Benjamin S, AU - Meldrum,Craig, AU - Hyzy,Robert C, Y1 - 2021/02/24/ PY - 2020/05/07/received PY - 2021/01/23/revised PY - 2021/02/14/accepted PY - 2021/3/14/pubmed PY - 2021/8/31/medline PY - 2021/3/13/entrez KW - Critical care KW - Emergency ICU KW - ICU admission SP - 27 EP - 33 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 46 N2 - OBJECTIVE: Evaluate the impact of an emergency critical care center (EC3) on the admissions of critically ill patients to a critical care medicine unit (CCMU) and their outcomes. METHODS: This was a retrospective before/after cohort study in a tertiary university teaching hospital. To improve the care of critically ill patients in the emergency department (ED), a 9-bed EC3 was opened in the ED in February 2015. All critically ill patients in the emergency department must receive intensive support in EC3 before being considered for admission to the CCMU for further treatment. Patients from the emergency department account for a significant proportion of the patients admitted to the CCMU. The proportions of patients admitted to the CCMU from the ED were analyzed 1 year before and 1 year after the opening of the EC3. We also compared the admission data, demographic data, APACHE III scores and patient outcomes among patients admitted from ED to the CCMU in the year before and the year after the opening of the EC3. RESULT: The establishment of the EC3 was associated with a decreased proportion of patients admitted to the CCMU from the ED (OR 0.73 95% CI 0.63-0.84, p < 0.01), a decrease in the proportion of patients with sepsis admitted from the ED (OR 0.68, 95% CI, 0.54-0.87, p < 0.01) and a decrease in the proportion of patients with gastrointestinal bleeding admitted from the ED (OR 0.49, 95% CI 0.28-0.84, p < 0.05). Following the establishment of the EC3, patients admitted to the CCMU had a higher APACHE III score in 2015 (74.85 ± 30.42 vs 72.39 ± 29.64, p = 0.015). Fewer low-risk patients were admitted to the CCMU for monitoring following the opening of the EC3 (112 [6.8%] vs. 181 [9.3%], p < 0.01). Propensity score matching analysis showed that the opening of the EC3 was associated with improved 60-day survival (HR 0.84, 95% CI 0.70-0.99, p = 0.046). CONCLUSION: Following the opening of the EC3, the proportion of CCMU admissions from the ED decreased. The EC3 may be most effective at reducing the admission of lower-acuity patients with GI bleeding and possibly sepsis. The EC3 may be associated with improved survival in ED patients. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/33714051/Effect_of_an_emergency_department_intensive_care_unit_on_medical_intensive_unit_admissions_and_care:_A_retrospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(21)00145-5 DB - PRIME DP - Unbound Medicine ER -