In-Hospital Outcomes in Patients Admitted to the Intensive Care Unit After a Return Visit to the Emergency Department

Overview

Journal Healthcare (Basel)

Specialty Health Services

Date 2021 Apr 30

PMID 33917232

Citations 1

Authors

Chun-Fu Lin

Yi-Syun Huang

Ming-Ta Tsai

Kuan-Han Wu

Chien-Fu Lin

I-Min Chiu

Affiliations

Soon will be listed here.

Abstract

Background: Intensive care unit (ICU) admission following a short-term emergency department (ED) revisit has been considered a particularly undesirable outcome among return-visit patients, although their in-hospital prognosis has not been discussed. We aimed to compare clinical outcomes between adult patients admitted to the ICU after unscheduled ED revisits and those admitted during index ED visits.

Method: This retrospective study was conducted at two tertiary medical centers in Taiwan from 1 January 2016 to 31 December 2017. All adult non-trauma patients admitted to the ICU directly via the ED during the study period were included and divided into two comparison groups: patients admitted to the ICU during index ED visits and those admitted to the ICU during return ED visits. The outcomes of interest included in-hospital mortality, mechanical ventilation (MV) support, profound shock, hospital length of stay (HLOS), and total medical cost.

Results: Altogether, 12,075 patients with a mean (standard deviation) age of 64.6 (15.7) years were included. Among these, 5.3% were admitted to the ICU following a return ED visit within 14 days and 3.1% were admitted following a return ED visit within 7 days. After adjusting for confounding factors for multivariate regression analysis, ICU admission following an ED revisit within 14 days was not associated with an increased mortality rate (adjusted odds ratio (aOR): 1.08, 95% confidence interval (CI): 0.89 to 1.32), MV support (aOR: 1.06, 95% CI: 0.89 to 1.26), profound shock (aOR: 0.99, 95% CI: 0.84 to 1.18), prolonged HLOS (difference: 0.04 days, 95% CI: -1.02 to 1.09), and increased total medical cost (difference: USD 361, 95% CI: -303 to 1025). Similar results were observed after the regression analysis in patients that had a 7-day return visit.

Conclusion: ICU admission following a return ED visit was not associated with major in-hospital outcomes including mortality, MV support, shock, increased HLOS, or medical cost. Although ICU admissions following ED revisits are considered serious adverse events, they may not indicate poor prognosis in ED practice.

Citing Articles

Prediction of high-risk emergency department revisits from a machine-learning algorithm: a proof-of-concept study.

Sung C, Ho J, Fan C, Chen C, Chen C, Lin S BMJ Health Care Inform. 2024; 31(1).

PMID: 38649237 PMC: 11043771. DOI: 10.1136/bmjhci-2023-100859.

References

Naved S, Siddiqui S, Khan F . APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak. 2011; 21(1):4-8. DOI: 01.2011/JCPSP.0408. View

Brennan T, Leape L, Laird N, Hebert L, Localio A, Lawthers A . Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991; 324(6):370-6. DOI: 10.1056/NEJM199102073240604. View

Hu K, Lu Y, Lin H, Guo H, Foo N . Unscheduled return visits with and without admission post emergency department discharge. J Emerg Med. 2012; 43(6):1110-8. DOI: 10.1016/j.jemermed.2012.01.062. View

Jimenez-Puente A, Del Rio-Mata J, Arjona-Huertas J, Mora-Ordonez B, Martinez-Reina A, Martinez Del Campo M . Which unscheduled return visits indicate a quality-of-care issue?. Emerg Med J. 2016; 34(3):145-150. DOI: 10.1136/emermed-2015-205603. View

Fan J, Kao W, Yen D, Wang L, Huang C, Lee C . Risk factors and prognostic predictors of unexpected intensive care unit admission within 3 days after ED discharge. Am J Emerg Med. 2007; 25(9):1009-14. DOI: 10.1016/j.ajem.2007.03.005. View

Nguyen T, Hillman K, Buist M . Adverse events in British hospitals. Preventive strategies, not epidemiological studies, are needed. BMJ. 2001; 322(7299):1425; author reply 1427. PMC: 1120482. View

Cardoso L, Grion C, Matsuo T, Anami E, Kauss I, Seko L . Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011; 15(1):R28. PMC: 3222064. DOI: 10.1186/cc9975. View

Cheng J, Shroff A, Khan N, Jain S . Emergency Department Return Visits Resulting in Admission: Do They Reflect Quality of Care?. Am J Med Qual. 2015; 31(6):541-551. DOI: 10.1177/1062860615594879. View

Parkhe M, Myles P, Leach D, Maclean A . Outcome of emergency department patients with delayed admission to an intensive care unit. Emerg Med (Fremantle). 2002; 14(1):50-7. DOI: 10.1046/j.1442-2026.2002.00286.x. View

10.

Tsai I, Sun C, Chang C, Lee K, Liang C, Hsu C . Characteristics and outcomes of patients with emergency department revisits within 72 hours and subsequent admission to the intensive care unit. Tzu Chi Med J. 2017; 28(4):151-156. PMC: 5442903. DOI: 10.1016/j.tcmj.2016.07.002. View

11.

Sabbatini A, Kocher K, Basu A, Hsia R . In-Hospital Outcomes and Costs Among Patients Hospitalized During a Return Visit to the Emergency Department. JAMA. 2016; 315(7):663-71. PMC: 8366576. DOI: 10.1001/jama.2016.0649. View

12.

Chen Y, Lin S, Liu C, Jiang D, Yang P, Chang S . Risk factors for ICU mortality in critically ill patients. J Formos Med Assoc. 2002; 100(10):656-61. View

13.

Verelst S, Pierloot S, Desruelles D, Gillet J, Bergs J . Short-term unscheduled return visits of adult patients to the emergency department. J Emerg Med. 2014; 47(2):131-9. DOI: 10.1016/j.jemermed.2014.01.016. View

14.

Rising K, Padrez K, OBrien M, Hollander J, Carr B, Shea J . Return visits to the emergency department: the patient perspective. Ann Emerg Med. 2014; 65(4):377-386.e3. DOI: 10.1016/j.annemergmed.2014.07.015. View

15.

Sills M, Macy M, Kocher K, Sabbatini A . Return Visit Admissions May Not Indicate Quality of Emergency Department Care for Children. Acad Emerg Med. 2017; 25(3):283-292. PMC: 5842107. DOI: 10.1111/acem.13324. View

16.

Pham J, Kirsch T, Hill P, DeRuggerio K, Hoffmann B . Seventy-two-hour returns may not be a good indicator of safety in the emergency department: a national study. Acad Emerg Med. 2011; 18(4):390-7. DOI: 10.1111/j.1553-2712.2011.01042.x. View

17.

Trivedy C, Cooke M . Unscheduled return visits (URV) in adults to the emergency department (ED): a rapid evidence assessment policy review. Emerg Med J. 2013; 32(4):324-9. DOI: 10.1136/emermed-2013-202719. View

18.

Rising K, Victor T, Hollander J, Carr B . Patient returns to the emergency department: the time-to-return curve. Acad Emerg Med. 2014; 21(8):864-71. DOI: 10.1111/acem.12442. View

19.

Chiang C, Cheng F, Huang Y, Chen Y, Wu K, Chiu I . ICU admission following an unscheduled return visit to the pediatric emergency department within 72 hours. BMC Pediatr. 2019; 19(1):268. PMC: 6676510. DOI: 10.1186/s12887-019-1644-y. View

20.

Christensen S, Johansen M, Christiansen C, Jensen R, Lemeshow S . Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care. Clin Epidemiol. 2011; 3:203-11. PMC: 3130905. DOI: 10.2147/CLEP.S20247. View