Quantification of Intensive Care Unit Care in an Urban Emergency Department

Background: Emergency department (ED) visits continue to rise nationally with up to 25% being critically ill patients. This contributes to both ED and hospital crowding, which in turn increases ED boarding times and the provision of care by ED personnel. The aim of this study was to quantitate ICU boarding in an urban, academic ED. Methods: This was a retrospective cohort study at an urban, academic ED with \u3e 100,000 annual patient visits where \u3e 15% are triaged to its highest acuity area. All consecutive adult hospital admissions over a 5-month period were included. Patients were excluded if admitted to labor and delivery, observation, or hospice care. Boarding time was defined as the time from when an admitting order was placed the time a patient arrived on an inpatient floor. Analysis was descriptive but also included univariate comparison of ICU and general practice unit (GPU) boarding time. Results: During the study period there were 6,665 inpatient admissions from the ED, of which 1,676 (24.9%) were ICU admissions. The mean age of ICU admissions was 61 ± 18 years, 49% were female, and 66% African American. The median ED LOS was 410 [IQR 293 - 557] minutes, and the median boarding time was 163 [IQR 112 - 241] minutes. Boarding was more than 6 hours in 10.3% and more than 12 hours in 1.3% of ICU admissions. The average ICU patient hours provided per day was 76.3 ± 39.8 hours per day or 3.2 ICU patient days. Of this overall time, 33.8 ± 24.8 hours was boarding time. Boarding times per patient for GPU vs. ICU bound patients were not significantly different (difference 6 minutes, 95% CI -1 to 13 minutes). Conclusion: This study demonstrates a significant contribution to consumption of health care resources as a result of ICU boarding. The equivalent resources of a 3-4 bed ICU are provided daily to patients. In centers that experience this burden, increased resources may be required to provide delivery of critical care in the ED