1149: IMPACT OF AN INTENSIVIST TEAM IN AN URBAN EMERGENCY DEPARTMENT

Abstract

Introduction: A seminal 2007 study found that critically-ill patients with a greater than six hour Emergency Department (ED) length of stay had a significant increase in intensive care unit (ICU) mortality (10.7% vs. 2.4%). Furthermore, U.S. ED’s have provide a 217% increase in critical care hours provided in U.S. ED’s. These two factors have likely been exacerbated by worsening ED boarding. To address the imminent need for critical care in the ED, we deployed an emergency medicine-intensivist team as a resource during the highest patient volume time at our tertiary care academic ED. Methods: We performed a retrospective analysis of patient management by the resource intensivist team (RIT) from September 2020 to October 2021. We compared patient characteristics managed by the RIT to those managed by the rest of the ED at that time as well as historical norms. The primary outcome was patients per hour seen by the emergency medicine physicians during the RIT deployment hours; secondary outcomes included length of stay (ED, ICU, and hospital), time to first antibiotic, time to first vasopressor, procedures per patient (PPP) and disposition level of care. Results: Over the study period, 88 patients were managed by the RIT and 2480 were managed by the emergency medicine physicians on-shift. While statistically significant, there was only a minimal difference in patients per hour (PPH) between the two groups (1.27 PPH vs 1.38 PPH). There was a significantly faster time to first antibiotic (2.41 hours vs 4.96 hours) with a trend towards faster time for first vasopressors (4.08hrs vs 5.79hrs, p=0.338). Additionally, 24.7% of patient initially triaged to critical care were transitioned to a lower level of care by the RIT without a change in their ED length of stay (10.60hrs vs 10.88hrs p = 0.703). Finally, significantly more procedures were performed on patients managed by the RIT (0.47 PPP vs 0.05 PPP). Conclusions: The addition of a resource intensivist model to our academic tertiary care ED significantly decreased the time to antimicrobial administration and allowed RIT residents to perform more procedures, and transitioned patients to lower levels of care without adversely affecting ED length of stay. Additional work is required to identify areas where a RIT can improve the care of patients in the ED.