287: ASSOCIATION BETWEEN AN EMERGENCY CRITICAL CARE PROGRAM AND DKA CRITICAL CARE UTILIZATION IN THE ED

Abstract

Introduction: The Stanford Emergency Critical Care Program (ECCP), in which a dual-boarded EM/CCM physician serves as an embedded consultant during hours of peak ED census, was initiated in 2017. We investigated the association between the ECCP intervention and critical care utilization in ED patients with Diabetic Ketoacidosis (DKA). Methods: This is a retrospective cohort analysis of adult DKA patients in the ED who were admitted to critical care between 2017-2019. Duration of critical care and ICU bed utilization by patients admitted during ECCP hours were compared to patients admitted during non-ECCP hours. Stata was used for all analyses. Results: Of 71 patients identified, 16 (23%) were in the ECCP cohort, and 55 (77%) were admitted outside ECCP hours. No demographic or baseline clinical differences were noted between groups, although ECCP patients had significantly lower initial glucose (419 vs 602, p=0.014). On univariable analysis, there was no significant difference in mortality or length of hospital stay. In terms of critical care utilization, however, ECCP patients were more likely to be downgraded to non-ICU level of care directly from the ED (93.8% vs 45.5%, p=0.001), and also specifically to be downgraded within 6 hours (62.5% vs 12.7%, p< 0.0001). Finally, total critical care duration was reduced during ECCP hours (5.4h vs 14.4h, p=0.0001). These findings remained significant upon multivariable analyses controlling for demographics and baseline clinical characteristics. Conclusions: DKA patients admitted to the ICU during ECCP hours were found to have decreased critical care duration and increased likelihood of downgrade to non-ICU level of care while still in the ED. These results suggest that early care by an embedded intensivist is associated with decreased critical care utilization among DKA patients in the ED. Future research should focus on prospective validation of these findings in a larger cohort, and identifying specific aspects of ECCP care that could be adapted for general ED use.