Evaluation of Emergency Service Admissions for Planning the Number of Intensive Care Beds in Hospitals

Abstract

A significant portion of intensive care unit (ICU) admissions occur through the emergency department (ED). Since there are insufficient ICU beds, critically ill patients may have to be monitored and treated in ED for an extended period. In this study, we aimed to show the importance of the emergency department intensive care unit (EDICU) and that ED applications should be taken into account in determining the number of intensive care unit (ICU) beds in hospitals by analyzing the patients hospitalized in intensive care units from the ED. In this retrospective descriptive study, patients over 18 who applied to the ED of a tertiary hospital between July 1, 2018, and July 1, 2019, and were deemed suitable for ICU admission were included. In descriptive statistics, percentages were used in categorical data, and mean, and standard deviation were used in numerical data. Chi-square test was applied for categorical variables. Since the distribution within the groups was normal in the analysis of continuous variables, one-way analysis of variance (ANOVA) was used when more than two groups were compared. The student's t-test was used when two groups were compared. Of the 2783 patients who applied to the ED and were suitable for admission to the ICU, 1341 (48.2%) were admitted to the second-level ICU, and 1442 (51.8%) were admitted to the third-level ICU. 1140 (40.96%) patients were hospitalized in the EDICU and toxicology ICU within the ED. These units played an important role in facilitating the ED operation and reducing crowding. Patients admitted to the ICU were divided into three groups based on their length of stay. Of the patients, 2312 (%83.1) were hospitalized in the first 6 hours, 337 (%12.1) in 6-12 hours, and 205 (7.36%) in more than 12 hours. It was observed that the mortality rate increased significantly when hospitalization in the ICU was delayed (P=0.014). ED admissions should be considered when determining the number of ICU beds and step levels of hospitals. In addition, the presence of EDICU in tertiary care hospitals relieves the density of the emergency department and indirectly reduces the mortality rate.