The Feasibility of Short-Term Emergency Intensive Care Model for Critically III Patients in Emergency Department

Abstract

Background: Little is known about the specific operative model of intensive care unit located in the emergency department (ED). The aim of this study was to demonstrate the short-term emergency and intensive care model can provide clinical benefits for acute critically ill patients in ED. Methods and Material: We prospectively enrolled all consecutive patients visiting our ED in a university-affiliated medical center at northern Taiwan from January 1(superscript st) to Dec 31(superscript th) in 2010. Patients with age more than 18 years, who were admitted to emergency intensive care unit (EICU), were recruited for retrospective analysis after ED visits. Patients' demographic data, triage category, time of EICU admission, major diagnosis, length of EICU stay, dispositions, and outcomes were analyzed. Multivariate logistic regression analysis was applied for risk predictors for mortality.Results: A total of 2,253 patients, with a mean age 72.9 ± 17.0 (SD) years and male predominant (70.4%). Ninety-four percent of patients belonged to Taiwan Triage and Acuity Scale (TTAS) level 1 to 3. An average of EICU stay was 38.1 ± 37.0 hours. The acute physiological and chronic health evaluation (APACHE) II score in admission decreased from 19.7 ± 9.1 to 18.4 ± 9.1 (p＜0.001), and sepsis patients by largest reduction 1.7 (95% CI, 1.1 to 2.2), followed by renal-related disease 1.6 (95% CI, 0.6 to 2.5) and acute respiratory failure 1.5 (95% CI, 1.1 to 1.9), respectively. The overall hospital mortality rate in all study patients was 30.8%, which can varied to 11.8% among 1412 patients without signing Do-Not-EICU associated with significant differences in hospital mortality. In regression analyses, male, higher acuity TTAS level, APACHE II score at admission and on transfer, hospital length of stay were risk factors associated with hospital mortality.Conclusion: Several risk factors associated with mortality were identified in our EICU patients, and this study demonstrated that our timely, efficiently, and effectively operative model, combination with emergency physician and other subspecialists, provide clinical advantages and be suggested to apply in health care system.