Accelerated Critical Therapy Now in the Emergency Department Using an Early Intervention Team: The Impact of Early Critical Care Consultation for ICU Boarders

Overview

Journal Crit Care Explor

Specialty Critical Care

Date 2022 Mar 23

PMID 35317241

Authors

Namita Jayaprakash

Jacqueline Pflaum-Carlson

Jayna Gardner-Gray

Gina Hurst

Harish Kinni

Amy Tang

Victor Coba

Emanuel P Rivers

Affiliations

Soon will be listed here.

Abstract

Design: Retrospective observational study from February 2018 to 2020.

Setting: An urban academic quaternary referral center.

Patients: Adult patients greater than or equal to 18 years admitted to the ICU from the ED. Exclusion criteria included age less than 18 years, do not resuscitate/do not intubate documented prior to arrival, advanced directives outlining limitations of care, and inability to calculate baseline modified Sequential Organ Failure Assessment (mSOFA) score.

Interventions: ED-based critical care consultation by an early intervention team (EIT) initiated by the primary emergency medicine physician compared with usual practice.

Measurements: The primary outcome was hospital LOS, and secondary outcomes were hospital mortality, ICU LOS, ventilator-free days, and change in the mSOFA.

Main Results: A total 1,764 patients met inclusion criteria, of which 492 (27.9%) were evaluated by EIT. Final analysis, excluding those without baseline mSOFA score, limited to 1,699 patients, 476 in EIT consultation group, and 1,223 in usual care group. Baseline mSOFA scores (±sd) were higher in the EIT consultation group at 3.6 (±2.4) versus 2.6 (±2.0) in the usual care group. After propensity score matching, there was no difference in the primary outcome: EIT consultation group had a median (interquartile range [IQR]) LOS of 7.0 days (4.0-13.0 d) compared with the usual care group median (IQR) LOS of 7.0 days (4.0-13.0 d), = 0.64. The median (IQR) boarding time was twice as long subjects in the EIT consultation group at 8.0 (5.0-15.0) compared with 4.0 (3.0-7.0) usual care, < 0.001.

Conclusions: An ED-based critical care consultation model did not impact hospital LOS. This model was used in the ED and the EIT cared for critically ill patients with higher severity of illness and longer ED boarding times.

Citing Articles

Rearranging the furniture: A blueprint for reappropriating fixed resources to create an emergency department resuscitative care unit.

Barskaya A, Abrukin L, McStay C J Am Coll Emerg Physicians Open. 2024; 5(3):e13211.

PMID: 38841296 PMC: 11150082. DOI: 10.1002/emp2.13211.

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