title: Outcomes of an emergency department intensive care unit in a tertiary medical center in Taiwan: An observational study.
abstract: OBJECTIVE
  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.
  
  
  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.
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan. Electronic address: jochi77@cgmh.org.tw.
authors: Jo-Chi
authors: JC
authors: Tseng
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan. Electronic address: chhli2002@gmail.com.
authors: Chih-Huang
authors: CH
authors: Li
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung, Keelung 20401, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Kweishan, Taoyuan 33302, Taiwan. Electronic address: kfchen@cgmh.org.tw.
authors: Kuan-Fu
authors: KF
authors: Chen
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan. Electronic address: ylchan@cgmh.org.tw.
authors: Yi-Ling
authors: YL
authors: Chan
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan. Electronic address: sschang@cgmh.org.tw.
authors: Shy-Shin
authors: SS
authors: Chang
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan. Electronic address: mr2563@cgmh.org.tw.
authors: Feng-Lin
authors: FL
authors: Wang
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan. Electronic address: tefachiu@cgmh.org.tw.
authors: Te-Fa
authors: TF
authors: Chiu
authors: Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan. Electronic address: jihchang@cgmh.org.tw.
authors: Jih-Chang
authors: JC
authors: Chen
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D016638:Critical Illness / Q000401:mortality; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006772:Hospitals, Military; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D013624:Taiwan; D014481:United States
keywords: Boarding; Critically ill patients; Emergency department; Hazard ratio; In-hospital mortality; Intensive care unit