title: Increasing critical care admissions from U.S. emergency departments, 2001-2009.
abstract: OBJECTIVE
  Little is known about how recent system-wide increases in demand for critical care have affected U.S. emergency departments (EDs). This study describes changes in the amount of critical care provided in U.S. EDs between 2001 and 2009.
  
  
  METHODS
  Analysis of data from the National Hospital Ambulatory Medical Care Survey for the years 2001-2009.
  
  
  METHODS
  National multistage probability sample of U.S. ED data. U.S. ED capacity was estimated using the National Emergency Department Inventory-United States.
  
  
  METHODS
  : ED patients admitted a critical care unit.
  
  
  METHODS
  None.
  
  
  METHODS
  Annual hours of ED-based critical care and annual number critical care ED visits. Clinical characteristics, demographics, insurance status, setting, geographic region, and ED length of stay for critically ill ED patients.
  
  
  RESULTS
  Annual critical care unit admissions from U.S. EDs increased by 79% from 1.2 to 2.2 million. The proportion of all ED visits resulting in critical care unit admission increased from 0.9% to 1.6% (ptrend < 0.001). Between 2001 and 2009, the median ED length of stay for critically ill patients increased from 185 to 245 minutes (+ 60 min; ptrend < 0.02). For the aggregated years 2001-2009, ED length of stay for critical care visits was longer among black patients (12.6% longer) and Hispanic patients (14.8% longer) than among white patients, and one third of all critical care ED visits had an ED length of stay greater than 6 hrs. Between 2001 and 2009, total annual hours of critical care at U.S. EDs increased by 217% from 3.2 to 10.1 million (ptrend < 0.001). The average daily amount of critical care provided in U.S. EDs tripled from 1.8 to 5.6 hours per ED per day.
  
  
  CONCLUSIONS
  The amount of critical care provided in U.S. EDs has increased substantially over the past decade, driven by increasing numbers of critical care ED visits and lengthening ED length of stay. Increased critical care burden will further stress an already overcapacity U.S. emergency care system.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA, USA. aherring@acmedctr.org
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Herring
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.forename: Jahan
authors.initials: J
authors.lastname: Fahimi
authors.forename: Harrison J
authors.initials: HJ
authors.lastname: Alter
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.forename: Janice A
authors.initials: JA
authors.lastname: Espinola
authors.forename: Ashley F
authors.initials: AF
authors.lastname: Sullivan
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003422:Critical Care / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D017721:Hospital Costs; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D018570:Risk Assessment; D017678:Sex Distribution; D014481:United States; D055815:Young Adult