Tseng Jo-Chi, Li Chih-Huang, Chen Kuan-Fu, Chan Yi-Ling, Chang Shy-Shin, Wang Feng-Lin, Chiu Te-Fa, Chen Jih-Chang
Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Kweishan, Taoyuan 33305, Taiwan.
Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung, Keelung 20401, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Kweishan, Taoyuan 33302, Taiwan.
J Crit Care. 2015 Jun;30(3):444-8. doi: 10.1016/j.jcrc.2015.01.010. Epub 2015 Jan 14.
The boarding of critically ill patients in the emergency department (ED) could reduce quality of care and increase mortality. An ED intensive care unit (ICU) was set up in a 3715-bed medical center to facilitate timely delivery of critical care. This study reports comparative outcomes of EDICU patients with specialty ICU patients.
Medical records of adult nontrauma ED patients admitted to nonsurgical ICUs (EDICU, medical, cardiac, alimentary, and neurological units) between January 2007 and July 2011 were retrospectively reviewed. The respective number of admissions, bed turnover rate, and length of stay were compared. Cox regression models were also applied to compare inhospital mortality risks among these patients.
With only 13% (14/108) of all ICU beds, EDICU admitted 36% (3711/10449) of patients. Emergency department ICU patients had an unfavorable adjusted hazard ratio for inhospital mortality compared with medical ICU and cardiac ICU patients, but after excluding patients with an ICU length of stay of 2 days or less, the difference in hazard ratio became nonsignificant.
Emergency department ICU has admitted a disproportionately higher proportion of patients without sacrificing quality of care. Specialty care could be secured through direct communication between EDICU and specialty physicians and forming close collaboration between departments and ICUs.
危重症患者滞留在急诊科可能会降低医疗质量并增加死亡率。一家拥有3715张床位的医疗中心设立了急诊科重症监护病房（EDICU），以促进危重症护理的及时提供。本研究报告了EDICU患者与专科重症监护病房患者的对比结果。
回顾性分析2007年1月至2011年7月期间入住非手术重症监护病房（EDICU、内科、心脏科、消化科和神经科病房）的成年非创伤性急诊科患者的病历。比较了各自的入院人数、床位周转率和住院时间。还应用Cox回归模型比较这些患者的院内死亡风险。
EDICU仅占所有重症监护病床的13%（14/108），却收治了36%（3711/10449）的患者。与内科重症监护病房和心脏重症监护病房的患者相比，急诊科重症监护病房患者的院内死亡调整后风险比不利，但在排除重症监护病房住院时间为2天或更短的患者后，风险比的差异变得不显著。
急诊科重症监护病房收治的患者比例过高，但并未牺牲医疗质量。通过EDICU与专科医生之间的直接沟通以及各科室与重症监护病房之间建立密切合作，可以确保专科护理服务
