Henrique Alencastro Puls, MD
House-Officer IV
University of Michigan
Ann Arbor, MI
Disclosure information not submitted.
Nathan Haas, MD
Assistant Professor of Emergency Medicine
n/a, United States
Disclosure information not submitted.
James Cranford, PhD
Associate Research Scientist
Hurley Medical Center, United States
Disclosure information not submitted.
Richard Medlin, MD, MSIS
Associate Chief Medical Information Officer
University of Michigan, United States
Disclosure information not submitted.
Benjamin Bassin, MD
Director of Operations, Emergency Critical Care Center
University of Michigan
Ann Arbor, Michigan, United States
Disclosure information not submitted.
Title: Emergency Department length of stay before care in an Emergency Department-based Intensive Care Unit
Introduction: Emergency department (ED) boarding of critically ill patients is associated with poor outcomes. ED-ICUs were created to mitigate ED boarding via expedited bed availability and early delivery of critical care. Given the lack of published data specific to ED-ICUs, our objective was to analyze the impact of ED length of stay (LOS) before transfer to ED-ICU on patient-oriented outcomes.
Methods: This is a retrospective analysis of all ED patients ≥ 18 years old dispositioned directly from the ED to the ED-ICU between 08/01/17 and 07/01/20 at a single U.S. academic medical center. Patients receiving end-of-life care were excluded. Bivariate and multivariable linear regressions were used to test for ED LOS as a predictor of ICU LOS and hospital LOS, and separate bivariate and multivariable logistic regressions were used to test for ED LOS as a predictor of the odds of ICU admission, 24-hr, 48-hr, hospital, and 30-day mortality. Multivariable analyses’ covariates were age, gender, Charlson Comorbidity Index (CCI), Emergency Severity Index, and eSimplified Acute Physiology Score (eSAPS3).
Results: We included 5,859 ED visits with subsequent care in the ED-ICU. Median (IQR) age, CCI, ESAPS3, ED LOS, and ED-ICU LOS were 62 years (48-72), 5 (2-8), 46 (36-56), 3.6 h (2.5-5.3), and 8.5 h (5.3-13.4), respectively, and 46.3% were female. Dispositions from the ED-ICU were ICU admission (32.2%), admission to a non-ICU level of care (57.5%), discharge from ED-ICU (9.2%), and deceased (1.1%). Bivariate analysis showed negative correlation of ED LOS with hospital LOS (b -3.4, 95%CI -5.9, -1.0), ICU admission (OR .86, 95%CI .84, .88), 48-hr mortality (OR .89, 95%CI .82, .98), hospital mortality (OR .89, 95%CI .85, .92), and 30-day mortality (OR .94, 95%CI .91, .97), but no association with ICU LOS or 24-hr mortality. Multivariable analysis showed a negative association with ICU admission (OR .91, 95%CI .88, .93), though there were no associations with other outcomes.
Conclusions: We observed no significant associations between ED LOS prior to ED-ICU transfer and mortality, hospital, or ICU LOS. These findings suggest an ED-ICU may help mitigate the risks of prolonged ED boarding of critically ill patients by delivering ICU-level care when the need is first identified rather than when a bed is available.