A “Code ICU” expedited review of critically ill patients is associated with reduced emergency department length of stay and duration of mechanical ventilation

Durie, Matthew; Darvall, Jai; Hadley, Daniel; Tacey, Mark

doi:10.1016/j.jcrc.2017.07.011

Cited by 12 publications

(7 citation statements)

References 18 publications

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“…Other MEP were not included in the study. An Australian study could show that MEP received by an ICU based trigger team had a shorter length of stay (24). Here, the setup did not include emergency physicians.…”

Section: Resultsmentioning

confidence: 99%

Trigger team activation for acute patients. A cohort study at a level 1 university hospital in Denmark

Posth

Froberg

et al. 2020

Preprint

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Background While patients with major trauma, suspected ST-elevation myocardial infarction (STEMI) or stroke have implemented pathways for quick access to specialized trigger teams, other patients with time dependent diseases present with less obvious aetiology and have less documented pathways at arrival to the hospital. Aim To describe the number, diagnosis and prognosis of patients arriving to the trigger teams for trauma, suspected STEMI, suspected stroke, and Medical emergency patients (MEP) Method Retrospective cohort study of all patients who between November 2012 and September 2015 had either a trauma, STEMI, stroke or MEP trigger team activation at arrival to Odense University Hospital – a level 1 trauma centre, a direct referral centre for patients with suspected STEMI to the catheterization laboratory or stroke, and with a trigger team at emergency department arrival of MEP patients from the local area. Results There were 8,075 activations of a trigger team at hospital arrival, median 7.6 calls per day (range 1-18); 16.7% trauma, 28.3% STEMI, 19.7% stroke and 35.3% MEP calls. This corresponds to 161/100,000 person years (py) with trauma calls, 64/100,000 py STEMI calls, 72/100,000 py stroke calls and 340/100,000 py MEP calls. Patients from the different calls had a 30-day mortality of 12% (trauma), 8% (STEMI), 5% (stroke), and 25% (MEP). Whereas patients from trauma, STEMI and stroke calls were mainly discharged within a few ICD10 (International classification of diseases, version 10) main coding areas, patients from MEP calls had discharge diagnosis within many different ICD10 main coding areas. Conclusion Trauma, STEMI and stroke trigger teams are used at a daily base, treat a prehospitally well-defined patient population and have a relatively low 7-day mortality. Patients with MEP calls are more frequent, have a diverse aetiology and a higher mortality than patients in the other trigger teams.

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Section: Resultsmentioning

confidence: 99%

Trigger team activation for acute patients. A cohort study at a level 1 university hospital in Denmark

Posth

Froberg

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Development of ICU admission prioritization guidelines and trauma standardization efforts are likely responsible for these improvements. 4,22,[24][25][26][27][28][29][30] The current pandemic forces intensivists to make difficult decisions in how to best use critical care resources. These data, in addition to triage scores and early warning systems may help support intensivists in the ICU admission prioritization decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Length of Stay and Mortality in Critically Injured Patients

Stey

Kanzaria

Dudley

et al. 2021

J Intensive Care Med

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Objective: Multicenter data from 2 decades ago demonstrated that critically ill and injured patients spending more than 6 hours in the emergency department (ED) before transfer to the intensive care unit (ICU) had higher mortality rates. A contemporary analysis of ED length of stay in critically injured patients at American College of Surgeons’ Trauma Quality Improvement Program (ACS-TQIP) centers was performed to test whether prolonged ED length of stay is still associated with mortality. Methods: This was an observational cohort study of critically injured patients admitted directly to ICU from the ED in ACS-TQIP centers from 2010-2015. Spending more than 6 hours in the ED was defined as prolonged ED length of stay. Patients with prolonged ED length of stay were matched to those with non-prolonged ED length of stay and mortality was compared. Main Results: A total of 113,097 patients were directly admitted from the ED to the ICU following injury. The median ED length of stay was 167 minutes. Prolonged ED length of stay occurred in 15,279 (13.5%) of patients. Women accounted for 29.4% of patients with prolonged ED length of stay but only 25.8% of patients with non-prolonged ED length of stay, P < 0.0001. Mortality rates were similar after matching—4.5% among patients with prolonged ED length of stay versus 4.2% among matched controls. Multivariable logistic regression of the matched cohorts demonstrated prolonged ED length of stay was not associated with mortality. However, women had higher adjusted mortality compared to men Odds Ratio = 1.41, 95% Confidence Interval 1.28 -1.61, P < 0.0001. Conclusion: Prolonged ED length of stay is no longer associated with mortality among critically injured patients. Women are more likely to have prolonged ED length of stay and mortality.

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“…The shorter ED LOS when patients were managed by team is in line with other studies. 13 17 Prolonged ED LOS is thought to impact on quality of initial care, and can thus cause prolonged ventilator time in the ICU and even increase mortality. 12 It seems logical that a multidisciplinary team with more people and better critical care competencies manages patients quicker and with higher quality than standard care management.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that critically ill patients in need of intensive care unit (ICU) admission could receive suboptimal care in the ED and that prolonged ED length of stay (LOS) may cause sentinel events and even increase mortality. [12][13][14] Despite this and the knowledge about the positive effect of emergency response teams for other patient groups, only a few studies have investigated the use of emergency response teams for critically ill general medical patients in the ED. These studies found that although many EDs do not use such teams, team management could ensure early diagnosis and treatment and a shorter ED LOS.…”

Section: Open Accessmentioning

confidence: 99%

Quality of care, resource use and patient outcome by use of emergency response team compared with standard care for critically ill medical patients in the emergency department: a retrospective single-centre cohort study from Norway

et al. 2021

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ObjectiveThe study aimed to investigate quality of care, resource use and patient outcome in management by an emergency response team versus standard care for critically ill medical patients in the emergency department (ED). The emergency response team was multidisciplinary and had eight members, with a registrar in internal medicine as team leader.DesignRegister-based retrospective cohort study.SettingTertiary hospital in Norway.ParticipantsThe study included 1120 patients with National Early Warning Score 2 (NEWS2) 5–10 points from 2015 and 2016. Patients missing ≥3 NEWS2 part scores, <18 years and with orders ‘Not for ICU’ or ‘Not for resuscitation’ were excluded.Outcome measuresQuality of care: pain assessment documented, analgesics given within 20 min, complete set of vital signs documented and antibiotics within 60 min if sepsis. Resource use: >3 diagnostic interventions, critical care in the ED and ED length of stay (LOS) <180 min. Patient outcome: intensive care unit (ICU) admission, ICU LOS <66 hours, hospital LOS <194 hours and mortality.ResultsThe median age was 66 years, 53.5% were male, 44.3% were admitted to the ICU and the mortality rate was 10.6%. Altogether 691 patients received team management and 429 standard care. Team management had a positive association with ‘complete set of vital signs documented’ (OR 1.720, CI 1.254 to 2.360), ‘analgesics given within 20 minutes’ (OR 3.268, CI 1.375 to 7.767) and ‘antibiotics within 60 minutes if sepsis’ (OR 7.880, CI 3.322 to 18.691), but a negative association with ‘ pain assessment documented’ (OR 0.068, CI 0.037 to 0.128). Team management was also associated with ‘critical care in the ED’ (OR 9.900, CI 7.127 to 13.751), ‘ED LOS <180 min’ (OR 2.944, CI 2.070 to 4.187), ‘ICU admission’ (OR 2.763, CI 1.962 to 3.891) and ‘mortality’ (OR 1.882, CI 1.142 to 3.102).ConclusionsTeam management showed positive results for quality of care and resource use. The results for later outcomes such as mortality, ICU LOS and hospital LOS were more ambiguous.

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A “Code ICU” expedited review of critically ill patients is associated with reduced emergency department length of stay and duration of mechanical ventilation

Cited by 12 publications

References 18 publications

Trigger team activation for acute patients. A cohort study at a level 1 university hospital in Denmark

Trigger team activation for acute patients. A cohort study at a level 1 university hospital in Denmark

Emergency Department Length of Stay and Mortality in Critically Injured Patients

Quality of care, resource use and patient outcome by use of emergency response team compared with standard care for critically ill medical patients in the emergency department: a retrospective single-centre cohort study from Norway

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