title: The effect of emergency department delay on outcome in critically ill medical patients: evaluation using hospital mortality and quality of life at 6 months.
abstract: OBJECTIVE
  To assess the impact of delay in emergency department (ED) on outcome of critically ill patients admitted to the medical intensive care unit (MICU). Outcome was defined as hospital mortality and as health-related quality of life (HRQoL) at 6 months after intensive care assessed by the 15D measure. The 15D is a generic, 15-dimensional, standardized measure of HRQoL. We hypothesized that prolonged stay in the ED is related to worse outcome.
  
  
  METHODS
  A prospective follow-up cohort study in university hospital.
  
  
  METHODS
  All consecutive 1675 patients admitted to the MICU between July 2002 and June 2004.
  
  
  RESULTS
  The 15D questionnaire was mailed to all patients alive at 6 months after admission. Of all MICU patients, 64% were admitted from ED. The mean length of stay in the ED was 6.2 h (95%CI 5.9-6.5 h). The hospital mortality rate was 24.4% (20.0% in the ED vs. 33.0% in the non-ED cohort, P < 0.001) and it was associated with higher age and degree of physiological derangement at admission. Neither the length of ED stay was associated with hospital mortality (P = 0.82) nor with HRQoL at 6 months after MICU admission (P = 0.34). Altogether, HRQoL at 6 months was significantly lower compared with the age- and sex-matched general population (P < 0.001).
  
  
  CONCLUSIONS
  In a university hospital, the length of ED stay was not associated with the outcome of critically ill medical patients. However, we feel that the effect of ED treatment and delay on outcome and outcome prediction in the critically ill patients deserves further evaluation.
authors.affiliation: Emergency Care, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. katri.saukkonen@helsinki.fi
authors.forename: K A
authors.initials: KA
authors.lastname: Saukkonen
authors.forename: M
authors.initials: M
authors.lastname: Varpula
authors.forename: P
authors.initials: P
authors.lastname: Räsänen
authors.forename: R P
authors.initials: RP
authors.lastname: Roine
authors.forename: L-M
authors.initials: LM
authors.lastname: Voipio-Pulkki
authors.forename: V
authors.initials: V
authors.lastname: Pettilä
mesh_terms: D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000534:rehabilitation / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D013997:Time Factors