Identifying ‘at-risk’ critically ill patients who present to the emergency department and require intensive care unit admission: A retrospective observational cohort study

2020 ◽  
Author(s):  
Julia Crilly ◽  
Amy Sweeny ◽  
John O'Dwyer ◽  
Brent Richards ◽  
David Green ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Cohort Study ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Cohort Study ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

scholarly journals Factors contributing to delay intensive care unit admission of critically ill patients from the adult emergency Department in Tikur Anbessa Specialized Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Helen Teklie ◽  
Hywet Engida ◽  
Birhanu Melaku ◽  
Abdata Workina
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Transfer Time ◽  
Multivariate Logistic Regression ◽  
Icu Admission ◽  
Specialized Hospital

Abstract Background The transfer time for critically ill patients from the emergency department (ED) to the Intensive care unit (ICU) must be minimal; however, some factors prolong the transfer time, which may delay intensive care treatment and adversely affect the patient’s outcome. Purpose To identify factors affecting intensive care unit admission of critically ill patients from the emergency department. Patients and methods A cross-sectional study design was conducted from January 13 to April 12, 2020, at the emergency department of Tikur Anbesa Specialized Hospital. All critically ill patients who need intensive care unit admission during the study period were included in the study. A pretested structured questionnaire was adapted from similar studies. The data were collected by chart review and observation. Then checked data were entered into Epi-data version 4.1 and cleaned data was exported to SPSS Version 25 for analysis. Descriptive statistics, bivariate and multivariate logistic regression were used to analyze the data. Result From the total of 102 critically ill patients who need ICU admission 84.3% of them had prolonged lengths of ED stay. The median length of ED stay was 13.5 h with an IQR of 7–25.5 h. The most common reasons for delayed ICU admission were shortage of ICU beds 56 (65.1%) and delays in radiological examination results 13(15.1%). On multivariate logistic regression p < 0.05 male gender (AOR = 0.175, 95% CI: (0.044, 0.693)) and shortage of ICU bed (AOR = 0.022, 95% CI: (0.002, 0.201)) were found to have a significant association with delayed intensive care unit admission. Conclusion there was a delay in ICU admission of critically ill patients from the ED. Shortage of ICU bed and delay in radiological investigation results were the reasons for the prolonged ED stay.

scholarly journals Intensive care unit admission protocol controlled by intensivists can reduce transfer delays from the emergency department in critically ill patients

2018 ◽  
Vol 26 (2) ◽  
pp. 84-90 ◽  
Author(s):  
Ji Eun Kim ◽  
Seul Lee ◽  
Jinwoo Jeong ◽  
Dong Hyun Lee ◽  
Jin-Heon Jeong
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Unit Admission ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Before And After

Background: Delayed transfer of patients from the emergency department to the intensive care unit is associated with adverse clinical outcomes. Critically ill patients with delayed admission to the intensive care unit had higher in-hospital mortality and increased hospital length of stay. Objectives: We investigated the effects of an intensive care unit admission protocol controlled by intensivists on the emergency department length of stay among critically ill patients. Methods: We designed the intensive care unit admission protocol to reduce the emergency department length of stay in critically ill patients. Full-time intensivists determined intensive care unit admission priorities based on the severity of illness. Data were gathered from patients who were admitted from the emergency department to the intensive care unit between 1 April 2016 and 30 November 2016. We retrospectively analyzed the clinical data and compared the emergency department length of stay between patients admitted from the emergency department to the intensive care unit before and after intervention. Results: We included 292 patients, 120 and 172 were admitted before and after application of the intensive care unit admission protocol, respectively. The demographic characteristics did not differ significantly between the groups. After intervention, the overall emergency department length of stay decreased significantly from 1045.5 (425.3–1665.3) min to 392.0 (279.3–686.8) min (p < 0.001). Intensive care unit length of stay also significantly decreased from 6.0 (4.0–11.8) days to 5.0 (3.0–10.0) days (p = 0.015). Conclusion: Our findings suggest that introduction of the intensive care unit admission protocol controlled by intensivists successfully decreased the emergency department length of stay and intensive care unit length of stay among critically ill patients at our institution.

Patients admitted via the emergency department to the intensive care unit: An observational cohort study

2018 ◽  
Vol 31 (2) ◽  
pp. 225-233
Author(s):  
Julia Crilly ◽  
Amy Sweeny ◽  
John O'Dwyer ◽  
Brent Richards ◽  
David Green ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Cohort Study ◽  
Intensive Care ◽  
Observational Cohort Study ◽  
Observational Cohort

scholarly journals The FRAIL-FIT study: Frailty’s relationship with adverse-event incidence in the longer term, at one year following intensive care unit treatment – A retrospective observational cohort study

2019 ◽  
Vol 21 (2) ◽  
pp. 124-133 ◽  
Author(s):  
David Hewitt ◽  
Malcolm G Booth
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Confidence Interval ◽  
Observational Cohort Study ◽  
Clinical Frailty Scale ◽  
Frail Patients ◽  
Observational Cohort ◽  
One Year ◽  
Retrospective Observational Cohort Study

Introduction Frailty is a syndrome of decreased reserve and heightened vulnerability. Frailty scoring has potential to facilitate more informed decisions in the intensive care unit. To validate this, its relationship with outcomes must be tested extensively. This study aimed to investigate frailty’s impact on adverse outcomes after intensive care unit admission, primarily one-year mortality. Methods This single-centre retrospective observational cohort study examined prospectively collected data from 400 intensive care unit patients. Frailty was assessed using the Clinical Frailty Scale and defined as Clinical Frailty Scale ≥ 5. Unadjusted and adjusted analyses tested the relationships of frailty, covariates and outcomes. Results Of 400 eligible patients, 111 (27.8%) were frail and 289 (72.3%) were non-frail. Compared to non-frail patients, frail patients were older (62 vs. 56, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation II scores (22 vs. 19, p < 0.001). Females were more likely to be frail than males (34.1% vs. 22.9% frail, p = 0.018). Frail patients were less likely to survive the intensive care unit (p = 0.03), hospital (p = 0.003) or to one year (p < 0.001). Frailty significantly increased one-year mortality hazards in unadjusted analyses (hazard ratio 1.96; 95% confidence interval 1.41–2.72; p < 0.001) and covariate adjusted analyses (hazard ratio 1.41; 95% confidence interval 1.00–1.98; p = 0.0497). Frail patients had more hospital admissions (p = 0.014) and longer hospital stays within both one year before (p = 0.002) and one year after intensive care unit admission (p = 0.012). Conclusions Frailty was common and associated with greater age, female gender, higher sickness severity and more healthcare use. Frailty was significantly associated with greater risks of mortality in both unadjusted and adjusted analyses. Frailty scoring is a promising tool which could improve decision making in intensive care.

Sign in / Sign up

Export Citation Format

Share Document