Outcomes of an emergency department intensive care unit in a tertiary medical center in Taiwan: An observational study.
PURPOSE
The boarding of critically ill patients in the emergency department (ED) could reduce quality of care and increase mortality. An ED intensive care unit (ICU) was set up in a 3715-bed medical center to facilitate timely delivery of critical care. This study reports comparative outcomes of EDICU patients with specialty ICU patients.


MATERIALS AND METHODS
Medical records of adult nontrauma ED patients admitted to nonsurgical ICUs (EDICU, medical, cardiac, alimentary, and neurological units) between January 2007 and July 2011 were retrospectively reviewed. The respective number of admissions, bed turnover rate, and length of stay were compared. Cox regression models were also applied to compare inhospital mortality risks among these patients.


RESULTS
With only 13% (14/108) of all ICU beds, EDICU admitted 36% (3711/10449) of patients. Emergency department ICU patients had an unfavorable adjusted hazard ratio for inhospital mortality compared with medical ICU and cardiac ICU patients, but after excluding patients with an ICU length of stay of 2 days or less, the difference in hazard ratio became nonsignificant.


CONCLUSIONS
Emergency department ICU has admitted a disproportionately higher proportion of patients without sacrificing quality of care. Specialty care could be secured through direct communication between EDICU and specialty physicians and forming close collaboration between departments and ICUs.
['Tseng|Jo-Chi|JC|', 'Li|Chih-Huang|CH|', 'Chen|Kuan-Fu|KF|', 'Chan|Yi-Ling|YL|', 'Chang|Shy-Shin|SS|', 'Wang|Feng-Lin|FL|', 'Chiu|Te-Fa|TF|', 'Chen|Jih-Chang|JC|']
D000328:Adult D000369:Aged, 80 and over D016638:Critical Illness D004636:Emergency Service, Hospital D005260:Female D017052:Hospital Mortality D006772:Hospitals, Military D006801:Humans D007362:Intensive Care Units D007902:Length of Stay D017063:Outcome Assessment, Health Care D011787:Quality of Health Care D013624:Taiwan D014481:United States
Emergency department Intensive care unit Boarding Critically ill patients Hazard ratio In-hospital mortality