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An emergency department-based intensive care unit is associated with decreased hospital length of stay for upper gastrointestinal bleeding.
Am J Emerg Med. 2021 Dec; 50:173-177.AJ

Abstract

INTRODUCTION

Upper gastrointestinal bleeding (UGIB) is associated with substantial morbidity, mortality, and intensive care unit (ICU) utilization. Initial risk stratification and disposition from the Emergency Department (ED) can prove challenging due to limited data points during a short period of observation. An ED-based ICU (ED-ICU) may allow more rapid delivery of ICU-level care, though its impact on patients with UGIB is unknown.

METHODS

A retrospective observational study was conducted at a tertiary U.S. academic medical center. An ED-ICU (the Emergency Critical Care Center [EC3]) opened in February 2015. Patients presenting to the ED with UGIB undergoing esophagogastroduodenoscopy within 72 h were identified and analyzed. The Pre- and Post-EC3 cohorts included patients from 9/2/2012-2/15/2015 and 2/16/2015-6/30/2019.

RESULTS

We identified 3788 ED visits; 1033 Pre-EC3 and 2755 Post-EC3. Of Pre-EC3 visits, 200 were critically ill and admitted to ICU [Cohort A]. Of Post-EC3 visits, 682 were critically ill and managed in EC3 [Cohort B], whereas 61 were critically ill and admitted directly to ICU without care in EC3 [Cohort C]. The mean interval from ED presentation to ICU level care was shorter in Cohort B than A or C (3.8 vs 6.3 vs 7.7 h, p < 0.05). More patients in Cohort B received ICU level care within six hours of ED arrival (85.3 vs 52.0 vs 57.4%, p < 0.05). Mean hospital length of stay (LOS) was shorter in Cohort B than A or C (6.2 vs 7.3 vs 10.0 days, p < 0.05). In the Post-EC3 cohort, fewer patients were admitted to an ICU (9.3 vs 19.4%, p < 0.001). The rate of floor admission with transfer to ICU within 24 h was similar. No differences in absolute or risk-adjusted mortality were observed.

CONCLUSION

For critically ill ED patients with UGIB, implementation of an ED-ICU was associated with reductions in rate of ICU admission and hospital LOS, with no differences in safety outcomes.

Authors+Show Affiliations

Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Michigan Center for Integrative Research in Critical Care, Ann Arbor, MI, USA. Electronic address: haasn@med.umich.edu.Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Michigan Center for Integrative Research in Critical Care, Ann Arbor, MI, USA.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

34371325

Citation

Haas, Nathan L., et al. "An Emergency Department-based Intensive Care Unit Is Associated With Decreased Hospital Length of Stay for Upper Gastrointestinal Bleeding." The American Journal of Emergency Medicine, vol. 50, 2021, pp. 173-177.
Haas NL, Medlin RP, Cranford JA, et al. An emergency department-based intensive care unit is associated with decreased hospital length of stay for upper gastrointestinal bleeding. Am J Emerg Med. 2021;50:173-177.
Haas, N. L., Medlin, R. P., Cranford, J. A., Boyd, C., Havey, R. A., Losman, E. D., Rice, M. D., & Bassin, B. S. (2021). An emergency department-based intensive care unit is associated with decreased hospital length of stay for upper gastrointestinal bleeding. The American Journal of Emergency Medicine, 50, 173-177. https://doi.org/10.1016/j.ajem.2021.07.057
Haas NL, et al. An Emergency Department-based Intensive Care Unit Is Associated With Decreased Hospital Length of Stay for Upper Gastrointestinal Bleeding. Am J Emerg Med. 2021;50:173-177. PubMed PMID: 34371325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An emergency department-based intensive care unit is associated with decreased hospital length of stay for upper gastrointestinal bleeding. AU - Haas,Nathan L, AU - Medlin,Richard P,Jr AU - Cranford,James A, AU - Boyd,Caryn, AU - Havey,Renee A, AU - Losman,Eve D, AU - Rice,Michael D, AU - Bassin,Benjamin S, Y1 - 2021/07/31/ PY - 2021/03/10/received PY - 2021/06/28/revised PY - 2021/07/27/accepted PY - 2021/8/10/pubmed PY - 2021/12/21/medline PY - 2021/8/9/entrez KW - Emergency department KW - GI bleed KW - ICU SP - 173 EP - 177 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 50 N2 - INTRODUCTION: Upper gastrointestinal bleeding (UGIB) is associated with substantial morbidity, mortality, and intensive care unit (ICU) utilization. Initial risk stratification and disposition from the Emergency Department (ED) can prove challenging due to limited data points during a short period of observation. An ED-based ICU (ED-ICU) may allow more rapid delivery of ICU-level care, though its impact on patients with UGIB is unknown. METHODS: A retrospective observational study was conducted at a tertiary U.S. academic medical center. An ED-ICU (the Emergency Critical Care Center [EC3]) opened in February 2015. Patients presenting to the ED with UGIB undergoing esophagogastroduodenoscopy within 72 h were identified and analyzed. The Pre- and Post-EC3 cohorts included patients from 9/2/2012-2/15/2015 and 2/16/2015-6/30/2019. RESULTS: We identified 3788 ED visits; 1033 Pre-EC3 and 2755 Post-EC3. Of Pre-EC3 visits, 200 were critically ill and admitted to ICU [Cohort A]. Of Post-EC3 visits, 682 were critically ill and managed in EC3 [Cohort B], whereas 61 were critically ill and admitted directly to ICU without care in EC3 [Cohort C]. The mean interval from ED presentation to ICU level care was shorter in Cohort B than A or C (3.8 vs 6.3 vs 7.7 h, p < 0.05). More patients in Cohort B received ICU level care within six hours of ED arrival (85.3 vs 52.0 vs 57.4%, p < 0.05). Mean hospital length of stay (LOS) was shorter in Cohort B than A or C (6.2 vs 7.3 vs 10.0 days, p < 0.05). In the Post-EC3 cohort, fewer patients were admitted to an ICU (9.3 vs 19.4%, p < 0.001). The rate of floor admission with transfer to ICU within 24 h was similar. No differences in absolute or risk-adjusted mortality were observed. CONCLUSION: For critically ill ED patients with UGIB, implementation of an ED-ICU was associated with reductions in rate of ICU admission and hospital LOS, with no differences in safety outcomes. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/34371325/An_emergency_department_based_intensive_care_unit_is_associated_with_decreased_hospital_length_of_stay_for_upper_gastrointestinal_bleeding_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(21)00631-8 DB - PRIME DP - Unbound Medicine ER -