Emrullah KABINKARA, Ramazan KÖYLÜ, Nafis VURAL, Murat DUYAN

Evaluation of Emergency Service Admissions for Planning the Number of Intensive Care Beds in Hospitals

A significant portion of intensive care unit (ICU) admissions occur through the emergency department (ED). Since there are insufficient ICU beds, critically ill patients may have to be monitored and treated in ED for an extended period. In this study, we aimed to show the importance of the emergency department intensive care unit (EDICU) and that ED applications should be taken into account in determining the number of intensive care unit (ICU) beds in hospitals by analyzing the patients hospitalized in intensive care units from the ED. In this retrospective descriptive study, patients over 18 who applied to the ED of a tertiary hospital between July 1, 2018, and July 1, 2019, and were deemed suitable for ICU admission were included. In descriptive statistics, percentages were used in categorical data, and mean, and standard deviation were used in numerical data. Chi-square test was applied for categorical variables. Since the distribution within the groups was normal in the analysis of continuous variables, one-way analysis of variance (ANOVA) was used when more than two groups were compared. The student's t-test was used when two groups were compared. Of the 2783 patients who applied to the ED and were suitable for admission to the ICU, 1341 (48.2%) were admitted to the second-level ICU, and 1442 (51.8%) were admitted to the third-level ICU. 1140 (40.96%) patients were hospitalized in the EDICU and toxicology ICU within the ED. These units played an important role in facilitating the ED operation and reducing crowding. Patients admitted to the ICU were divided into three groups based on their length of stay. Of the patients, 2312 (%83.1) were hospitalized in the first 6 hours, 337 (%12.1) in 6-12 hours, and 205 (7.36%) in more than 12 hours. It was observed that the mortality rate increased significantly when hospitalization in the ICU was delayed (P=0.014). ED admissions should be considered when determining the number of ICU beds and step levels of hospitals. In addition, the presence of EDICU in tertiary care hospitals relieves the density of the emergency department and indirectly reduces the mortality rate.

Anahtar Kelimeler:

Emergency medicine, Intensive care, Hospitalization, Emergency department intensive care unit, Toxicology intensive care unit

Evaluation of Emergency Service Admissions for Planning the Number of Intensive Care Beds in Hospitals

Keywords:

Emergency medicine, Intensive care, Hospitalization, Emergency department intensive care unit, Toxicology intensive care unit,

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Affleck A, Parks P, Drummond A, Rowe BH, Ovens HJ. 2013. Emergency department overcrowding and access block. CJEM, 15(6): 359-370. DOI: 10.1017/S1481803500002451.
Al-Qahtani S, Alsultan A, Haddad S, Alsaawi A, Alshehri M, Alsolamy S, Felebaman A, Tamim HM, Aljerian N, Al-Dawood A, Arabi Y. 2017. The association of duration of boarding in the emergency room and the outcome of patients admitted to the intensive care unit. BMC Emerg Medic, 17: 34. DOI: 10.1186/S12873-017-0143-4.
Ansah JP, Ahmad S, Lee LH, Shen Y, Hock Ong ME, Bruce Matchar D, Schoenenberger L. 2021. Modeling emergency department crowding: Restoring the balance between demand for and supply of emergency medicine. PloS ONE, 16(1): e0244097. DOI: 10.1371/JOURNAL.PONE.0244097.
Aslaner MA, Akkaş M, Eroʇlu S, Aksu NM, Özmen MM. 2015. Admissions of critically ill patients to the ED intensive care unit. American j Emerg Medic, 33(4): 501-505. DOI: 10.1016/J.AJEM.2014.12.006.
Beeknoo N, Jones R. 2016. Achieving economy of scale in critical care, planning information necessary to support the choice of bed numbers. British J Medic Res, 17(9): 1-15. DOI: 10.9734/BJMMR/2016/28736.
Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, McConnell KJ, Pines JM, Rathlev N, Schafermeyer R, Zwemer F, Schull M, Asplin BR. 2009. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Medic, 16(1): 1-10. DOI: 10.1111/J.1553-2712.2008.00295.X.
Bertolini G, Rossi C, Brazzi L, Radrizzani D, Rossi G, Arrighi E, Simini B. 2003. The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study. Intens Care Medic, 29(12): 2307-2311. DOI: 10.1007/S00134-003-2019-1.
Cardoso LTQ, Grion CMC, Matsuo T, Anami EHT, Kauss IAM, Seko L, Bonametti AM. 2011. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Critical Care, 15(1): R28. DOI: 10.1186/CC9975.
Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP. 2007. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Critical Care Medic, 35(6): 1477-1483. DOI: 10.1097/01.CCM.0000266585.74905.5A.
Flabouris A, Jeyadoss J, Field J, Soulsby T. 2013. Association between emergency department length of stay and outcome of patients admitted either to a ward, intensive care or high dependency unit. Emerg Medic Australasia, 25(1): 46-54. DOI: 10.1111/1742-6723.12021.
Herring AA, Ginde AA, Fahimi J, Alter HJ, Maselli JH, Espinola JA, Sullivan AF, Camargo CA. 2013. Increasing critical care admissions from U.S. emergency departments, 2001–2009. Critical Care Medic, 41(5): 1197. DOI: 10.1097/CCM.0B013E31827C086F.
Horwitz LI, Green J, Bradley EH. 2010. US emergency department performance on wait time and length of visit. Annals Emerg Medic, 55(2): 133-141. DOI: 10.1016/J.ANNEMERGMED.2009.07.023.
Kekeç Z, Koç F, Büyük S. 2009. Review of geriatric patients hospitalization in emergency department. j Acad Emerg Medic, 8(3): 21-24. DOI: 10.4170/JAEM.2009.58070.
Lee KS, Min HS, Moon JY, Lim D, Kim Y, Ko E, Kim YS, Kim J, Lee J, Sung HK. 2022. Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea. BMC Emerg Medic, 22: 183. DOI: 10.1186/S12873-022-00745-Y.
Mullins PM, Goyal M, Pines JM. 2013. National growth in intensive care unit admissions from emergency departments in the United States from 2002 to 2009. Acad Emerg Medic, 20(5): 479-486. DOI: 10.1111/ACEM.12134.
Parkhe M, Myles PS, Leach DS, Maclean AV. 2002. Outcome of emergency department patients with delayed admission to an intensive care unit. Emerg Medic, 14(1): 50-57. DOI: 10.1046/J.1442-2026.2002.00286.X.
Rose L, Scales DC, Atzema C, Burns KEA, Gray S, Doing C, Kiss A, Rubenfeld G, Lee JS. 2016. Emergency department length of stay for critical care admissions. A population-based study. Annals American Thoracic Soc, 13(8): 1324-1332. DOI: 10.1513/ANNALSATS.201511-773OC.
Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, Bar-Lavi Y, Gurman G, Klein M, Lev A, Levi L, Zveibil F, Mandel M, Mnatzaganian G. 2004. Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care unit beds. Critical Care Medic, 32(8): 1654-1661. DOI: 10.1097/01.CCM.0000133021.22188.35.
Weingart SD, Sherwin RL, Emlet LL, Tawil I, Mayglothling J, Rittenberger JC. 2013. ED intensivists and ED intensive care units. American J Emerg Medic, 31(3): 617-620. DOI: 10.1016/J.AJEM.2012.10.015.
Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM. 2011. Comparison of medical admissions to intensive care units in the United States and United Kingdom. American J Respirat Critical Care Medic, 183(12): 1666-1673. DOI: 10.1164/RCCM.201012-1961OC.
Zhang Z, Bokhari F, Guo Y, Goyal H. 2019. Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission. Emerg Medic J, 36(2): 82-87. DOI: 10.1136/EMERMED-2018-208032.