Comparison of Emergency Department Boarders Managed by a Critical Care Consult Service versus Standard Care.
Emergency department critical care consult team linked to higher downgrade rate from intensive care unit-level care
Comparison of Emergency Department Boarders Managed by a Critical Care Consult Service versus Standard Care.
Emergency department (emergency department) boarding of critically ill patients awaiting intensive care unit (intensive care unit) admission has been associated with delays in time-sensitive interventions, prolonged lengths of stay (LOS), increased crowding, and higher incidence of morbidity and mortality.
Were sequentially identified via the electronic health record, and clinical and quality assurance data were collected in a REDCap database.
consult team linked to nearly triple the downgrade rate to lower-intensity care
During the study period, the emergency department critical care consult team was active on 73% of days, staffed primarily by resuscitation and emergency critical care fellows.
Of 372 eligible patients, 18% (68/372) were managed by the critical care consult team after initial assessment by primary emergency physician staff, while 82% (304/372) served as controls and did not have involvement with the critical care consult team.
These findings suggest that emergency department-based critical care physicians, including fellows in training, may facilitate earlier identification of patients suitable for lower levels of care despite initially higher acuity.
While there was no change in emergency department, intensive care unit, and hospital length of stay, it is possible that this is related to systemic problems with hospital bed availability.
The high rate of downgrades highlights the benefits of emergency department-based critical care physicians advancing care of critically ill patients boarding in the emergency department.