CRITICAL CARE OF MEDICAL AND SURGICAL PATIENTS IN THE ED - LENGTH OF STAY AND INITIATION OF INTENSIVE-CARE PROCEDURES

Little is known about the extent of critical care delivered to patient s in the emergency department (ED) and its impact on ED lengths of sta y or patient outcomes. The purpose of this study was to characterize t he timing of care for critically ill patients, both medical and surgic al, in the ED. The design was a retrospective review. The setting was a university teaching hospital. The subjects were ED patients subseque ntly admitted to a medical or surgical intensive care unit (ICU), The average length of stay in the ED was 367 minutes. Thirty percent of pa tients were bearded in the ED because of lack of beds in the ICU. Stab ilization procedures were performed on 45 (27%) patients, on average 1 02 minutes after ED admission, Monitoring procedures were performed on 35 (21%), on average 170 minutes after ED admission, There were no si gnificant differences in length of stay, use, and timing of critical p rocedures in medical and surgical patients. Critically ill patients re present a significant portion of ED patients and may remain in the ED for prolonged periods of time. One of the major contributors to these prolonged stays are lack of beds. Both resuscitative and monitoring pr ocedures are often performed in the ED setting for all types of critic al patients. The timing of these procedures indicates that they are pe rformed when necessary for patient care regardless of ED or ICU settin g. Thus, ICU care is often initiated and maintained in the ED setting. EDs must be staffed adequately with appropriately trained personnel t o care for these patients. Copyright (C) 1997 by W.B. Saunders Company .