scholarly journals Increased Length of Stay of Critically Ill Patients in the Emergency Department Associated with Higher In-hospital Mortality

2021 ◽  
Vol 25 (11) ◽  
pp. 1221-1225
Author(s):  
Ankur Verma ◽  
Amit Vishen ◽  
Meghna Haldar ◽  
Sanjay Jaiswal ◽  
Rinkey Ahuja ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients

Association of delayed time in the emergency department with the clinical outcomes for critically ill patients

QJM ◽  
2020 ◽  
Author(s):  
S Lin ◽  
S Ge ◽  
W He ◽  
M Zeng
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Waiting Time ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Stratified Analysis ◽  
Delayed Time

Summary Background Previous studies have shown the association of waiting time in the emergency department with the prognosis of critically ill patients, but these studies linking the waiting time to clinical outcomes have been inconsistent and limited by small sample size. Aim To determine the relationship between the waiting time in the emergency department and the clinical outcomes for critically ill patients in a large sample population. Design A retrospective cohort study of 13 634 patients. Methods We used the Medical Information Mart for Intensive Care III database. Multivariable logistic regression was used to determine the independent relationships of the in-hospital mortality rate with the delayed time and different groups. Interaction and stratified analysis were conducted to test whether the effect of delayed time differed across various subgroups. Results After adjustments, the in-hospital mortality in the ≥6 h group increased by 38.1% (OR 1.381, 95% CI 1.221–1.562). Moreover, each delayed hour was associated independently with a 1.0% increase in the risk of in-hospital mortality (OR 1.010, 95% CI 1.008–1.010). In the stratified analysis, intensive care unit (ICU) types, length of hospital stay, length of ICU stay, simplified acute physiology score II and diagnostic category were found to have interactions with ≥6 h group in in-hospital mortality. Conclusions In this large retrospective cohort study, every delayed hour was associated with an increase in mortality. Furthermore, clinicians should be cautious of patients diagnosed with sepsis, liver/renal/metabolic diseases, internal hemorrhage and cardiovascular disease, and if conditions permit, they should give priority to transferring to the corresponding ICUs.

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.

scholarly journals Use of Intravenous Vitamin C in Critically Ill Patients With COVID-19 Infection

2021 ◽  
pp. 089719002110150
Author(s):  
Matthew Li ◽  
Tsung Han Ching ◽  
Christopher Hipple ◽  
Ricardo Lopez ◽  
Asad Sahibzada ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vitamin C ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Objective ◽  
Primary Study ◽  
Protective Effects ◽  
Icu Length Of Stay ◽  
Intravenous Vitamin

Introduction The pathophysiology for Coronavirus Disease 2019 (COVID-19) infection is characterized by cytokine oxidative stress and endothelial dysfunction. Intravenous (IV) vitamin C has been utilized as adjuvant therapy in critically ill patients with sepsis for its protective effects against reactive oxygen species and immunomodulatory effects. The primary objective of this study was to evaluate the effects of IV vitamin C in critically ill patients with COVID-19 infection. Methods Retrospective observational cohort study with propensity score matching of intensive care unit (ICU) patients who received 1.5 grams IV vitamin C every 6 hours for up to 4 days for COVID-19 infection. The primary study outcome was in-hospital mortality. Secondary outcomes included vasopressor requirements in norepinephrine equivalents, ICU length of stay, and change in Sequential Organ Failure Assessment (SOFA) score. Results Eight patients received IV vitamin C and were matched to 24 patients. Patients in the IV vitamin C group had higher rates of hospital mortality [7 (88%) vs. 19 (79%), P = 0.049]. There was no difference in the daily vasopressor requirement in the treatment group or between the 2 groups. The mean SOFA scores post-treatment was higher in the IV vitamin C group (12.4 ± 2.8 vs. 8.1 ± 3.5, P < 0.005). There was no difference in ICU length of stay between the treatment and control groups. Conclusion Adjunctive IV vitamin C for the management of COVID-19 infection in critically ill patients may not decrease the incidence of mortality, vasopressor requirements, SOFA scores, or ventilator settings.

scholarly journals Emergency Department Length of Stay for Critically Ill Patients Followed Up in Red Zone

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Room ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Demographic Data ◽  
Waiting Times ◽  
Annual Number ◽  
Mortality And Morbidity ◽  
Lengths Of Stay

Objectives: The patients in red zone areas face acute or potentially life-threatening situations, complaints, vital disorders, diseases, or injuries that require emergent evaluation and treatment to prevent probable mortality and morbidity. We aimed to determine the variations in the lengths of stay of patients at the emergency department by examining different parameters and evaluate determinants that affect lengths of stay (in emergency room) of critically ill patients. Materials and Methods: All emergency department patients that were followed up in the red zone were included in this study. Patients’ demographic data, major complaints on admission, vital findings, performed procedures and examinations, elapsed time for the diagnoses, patients’ lengths of stay, and the causes of their prolonged waiting times were recorded and statistically analyzed. Results: The times elapsed for the diagnoses ranged between 6 min to 18 h in this study (mean: 1.62 ± 1.79 h). Patients’ lengths of stay was between 6 min to 58 h (mean length of stay was 5.51 ± 5.73 h). The waiting time for cases that required consultation (7.17 h) was found to be statistically longer than those cases that required no consultations (3.40 h). Conclusion: To prevent delays in emergency room to inpatient unit transfers, hospital administrators should manage their bed capacities to a level that is compatible with the annual number of patient admissions. Increasing the number of geriatric wards may facilitate inpatient transfers of patients over 60 years age from emergency room and shorten the length of stay of that age group.

scholarly journals Analysis of Factors Affecting the Length of Stay in the Emergency Department for Critically Ill Patients Transferred to Regional Emergency Medical Centers

2022 ◽  
Author(s):  
Hyungbok Lee ◽  
Sangrim Lee ◽  
Hyeoneui Kim
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prediction Models ◽  
Emergency Operation ◽  
Factors Affecting ◽  
Interhospital Transfer ◽  
Triage Level

Abstract BackgroundTransferring an emergency patient to another emergency department (ED) is necessary when she/he is unable to receive necessary treatment from the first visited ED, although the transfer poses potential risks for adverse clinical outcomes and lowering the quality of emergency medical services by overcrowding the transferred ED. This study aimed to understand the factors affecting the ED length of stay (LOS) of critically ill patients and to investigate whether they are receiving prompt treatment through Interhospital Transfer (IHT).MethodsThis study analyzed 968 critically ill patients transferred to the ED of the study site in 2019. Machine learning based prediction models were built to predict the ED LOS dichotomized as greater than 6 hours or less. Explanatory variables in patient characteristics, clinical characteristics, transfer-related characteristics, and ED characteristics were selected through univariate analyses.ResultsAmong the prediction models, the Logistic Regression (AUC 0.85) model showed the highest prediction performance, followed by Random Forest (AUC 0.83) and Naïve Bayes (AUC 0.83). The Logistic Regression model suggested that the need for emergency operation or angiography (OR 3.91, 95% CI=1.65–9.21), the need for Intensive Care Unit (ICU) admission (OR 3.84, 95% CI=2.53–5.83), fewer consultations (OR 3.57, 95% CI=2.84–4.49), a high triage level (OR 2.27, 95% CI=1.43–3.59), and fewer diagnoses (OR 1.32, 95% CI=1.09–1.61) coincided with a higher likelihood of 6-hour-or-less stays in the ED. Furthermore, an interhospital transfer handoff led to significantly shorter ED LOS among the patients who needed emergency operation or angiography, or ICU admission, or had a high triage level.ConclusionsThe results of this study suggest that patients prioritized in emergency treatment receive prompt intervention and leave the ED in time. Also, having a proper interhospital transfer handoff before IHT is crucial to provide efficient care and avoid unnecessarily longer stay in ED.

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