Monday May 28, 2007
Impact of delayed transfer of critically ill patients from emergency department to ICU


This is well known to Critical Care practitioners that critically ill patients does not desired treatment, if they continue to 'boarder' in emergency department. A very important study published this month in Criticare Care Medicine 1 regarding Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.

50,322 patients were divided into two groups: emergency department boarding more than/= 6 hrs (delayed n=1036) vs. emergency department boarding less than 6 hrs. (nondelayed n=49,286). Main outcomes were ICU and hospital survival and ICU and hospital length of stay.

Results:

• the median hospital length of stay was 7.0 (delayed) vs. 6.0 days (nondelayed).
• ICU mortality was 10.7% (delayed) vs. 8.4% (nondelayed).
• In-hospital mortality was 17.4% (delayed) vs. 12.9% (nondelayed).

Study concluded that, Critically ill emergency department patients with a more than/= 6-hr delay in intensive care unit transfer had increased hospital length of stay and higher intensive care unit and hospital mortality.

As said in discussion, the various factors which led to relatively poor outcome in ED 'boarders' icludes busy nature of ED practice, which entails simultaneous responsibilities for numerous patients of varying severities of illness, ED physicians and nurses may not be able to provide the focused one-on-one care that a critically ill patient may require, ED overcrowding and high patient acuity relative to the clinical staffing of the ED. ICU is a clinical environment that, by definition, enables close attention to the critically ill and allows for expeditious recognition of physiologic change and sudden deterioration, the ED under most circumstances is neither designed nor staffed to provide extended longitudinal care for the critically ill patient. It is also possible that there may be a different level of critical care expertise among the physicians and nurses who care for the patients who await ICU transfer, compared with the critical care expertise of the practitioners in the ICU setting.



Reference: click to get abstract

Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit - Critical Care Medicine. 35(6):1477-1483, June 2007.