The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit

BMC Emergency Medicine

Research Article

Hani M. Tamim¹  Samir Haddad²  Abdulaziz Al-Dawood³  Yaseen Arabi³  Saad Al-Qahtani³  Abdullah Alsultan⁴  Sami Alsolamy⁵  Nawfal Aljerian⁶  Abdulmohsen Alsaawi⁷  Moeed Alshehri⁷  Afef Felebaman⁸ 

[1] Department of Internal Medicine, American University of Beirut- Medical Center, Beirut, Lebanon;Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, 11426, Riyadh, Saudi Arabia;Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, 11426, Riyadh, Saudi Arabia;King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;Emergency Medicine and Intensive Care Department, College of Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia;King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia;King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia;King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;Obstetrics and Gynecology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia;

关键词: Emergency service, hospital;    ED boarding;    ICU;    Critical illness;    Retrospective studies;    Length of stay;    Hospital mortality;    Critical care;    Saudi Arabia;   

DOI  :  10.1186/s12873-017-0143-4

 received in 2017-01-27, accepted in 2017-10-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe demand for critical care beds is increasing out of proportion to bed availability. As a result, some critically ill patients are kept in the Emergency Department (ED boarding) awaiting bed availability. The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU).MethodsThis was a retrospective analysis of ICU data collected prospectively at King Abdulaziz Medical City, Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding. Patients were stratified into three groups according to the duration of boarding from ED. Those admitted less than 6 h were classified as Group I, between 6 and 24 h, Group II and more than 24 h as Group III. We carried out multivariate analysis to examine the independent association of boarding time with the outcome adjusting for variables like age, sex, APACHE, Mechanical ventilation, Creatinine, Platelets, INR.ResultsDuring the study period, 940 patients were admitted from the ED to ICU, amongst whom 227 (25%) were admitted to ICU within 6 h, 358 (39%) within 6–24 h and 355 (38%) after 24 h. Patients admitted to ICU within 6 h were younger [48.7 ± 22.2(group I) years, 50.6 ± 22.6 (group II), 58.2 ± 20.9 (group III) (P = 0.04)]with less mechanical ventilation duration[5.9 ± 8.9 days (Group I), 6.5 ± 8.1 (Group II) and 10.6 ± 10.5 (Group III), P = 0.04]. There was a significant increase in hospital mortality [51(22.5), 104(29.1), 132(37.2), P = 0.0006) and the ICU length of stay(LOS) [9.55 days (Group I), 9.8 (Group II) and 10.6 (Group III), (P = 0.002)] with increase in boarding duration. In addition, the delay in admission was an independent risk factor for ICU mortality(OR for group III vs group I is 1.90, P = 0.04) and hospital mortality(OR for group III vs Group I is 2.09, P = 0.007).ConclusionBoarding in the ED is associated with higher mortality. This data highlights the importance of this phenomenon and suggests the need for urgent measures to reduce boarding and to improve patient flow.

【 授权许可】

CC BY   
© The Author(s). 2017