Admissions of critically ill patients to the ED intensive care unit.
BACKGROUND
Many emergency departments (EDs) have established units capable of providing critical care because of increasing need for critical care, called as ED intensive care unit (EDICU). However, prolonged critical care leads to crowding, resulting in poor quality of care and high mortality rates. We aimed to determine which type of critically ill patients play a main role for crowding in the EDICU, and how to manage these patients.


METHODS
Patients aged older than 18 years who presented to the ED and presented for consultation to the ICU were eligible for inclusion in this study. Patients were classified into 4 priority groups by the Society of Critical Care Medicine.


RESULTS
Four hundred medical patients were enrolled in the study. Sixty-one patients were not admitted to hospital (15.2% of all patients) and were treated in the EDICU. These patients were older (mean age, 66.6 years) and had a higher percentage belonging to the priority 3 group (82.0%-unstable with reduced likelihood of recovery due to chronic illness) in comparison with other ICUs patients (mean age, 60.4 years and 11.9%, respectively) (P < .05). In priority 3 patients, the length of stay was median 120 hours, and also, length of invasive mechanical ventilations duration was median 19 hours in the EDICU.


CONCLUSIONS
Emergency department intensive care unit occupancy appears driven by categorized as "reduced benefit" patients, and these units tend to become alternative dumping grounds for palliative care services. Hospitals and health care administrators should take special care to develop policies for improving the management of these patients.
Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey. Electronic address: maliaslaner@hotmail.com.
Mehmet Ali
MA
Aslaner
Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Meltem
M
Akkaş
Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Sercan
S
Eroğlu
Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Nalan M
NM
Aksu
Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Mehmet Mahir
MM
Özmen
D018806:APACHE; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014218:Triage