Crilly Julia, Sweeny Amy, O'Dwyer John, Richards Brent, Green David, Marshall Andrea P
Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
Emerg Med Australas. 2019 Apr;31(2):225-233. doi: 10.1111/1742-6723.13123. Epub 2018 Jul 11.
Timely and appropriate assessment and management within the ED impacts patient outcomes including in-hospital mortality and length of stay (LOS). Within the ED, several processes facilitate timely recognition of the need for intensive care unit (ICU) admission. This study describes characteristics and outcomes for patient presentations admitted to ICU from ED, categorised by Australasian Triage Score (ATS), ICU admission time and ICU admission source.
A retrospective observational cohort study with linked health data of adult ICU admissions during 2012. Outcomes measured included: ED, ICU and hospital LOS, time to see ED clinician, ICU readmission and ICU and hospital mortality rates.
In total, 423 ICU admissions occurred within 24 h of ED arrival; 395 were admitted directly to ICU; 28 were admitted to the ward before ICU admission. ATS 3/4/5 patients comprised 26.7% of ICU admissions and experienced longer waits to be seen, longer total ED LOS, shorter ICU LOS and a lower mortality rate than those triaged ATS 1/2. Compared to ICU admissions during business hours, admissions outside hours did not differ significantly for any outcome measured. Patients admitted to the ward before ICU experienced longer waits to be seen and longer ED LOS.
Most patients are appropriately identified in ED as requiring ICU admission, although around one in four were triaged ATS 3/4. Patients admitted to the ward first tended to have poorer outcomes than those directly admitted to ICU. Factors predicting the need for ICU admission should be identified to support clinical decision-making.
急诊部（ED）内及时且恰当的评估与管理会影响患者的治疗结果，包括住院死亡率和住院时长（LOS）。在急诊部，有多个流程有助于及时识别重症监护病房（ICU）收治需求。本研究描述了从急诊部收治入ICU的患者特征及治疗结果，按澳大利亚分诊评分（ATS）、ICU收治时间和ICU收治来源进行分类。
一项回顾性观察队列研究，关联了2012年成人ICU收治的健康数据。测量的结果包括：急诊部、ICU和医院的住院时长，见到急诊部医生的时间，ICU再入院情况以及ICU和医院的死亡率。
总计423例患者在抵达急诊部后24小时内被收治入ICU；395例直接被收治入ICU；28例在收治入ICU前被收治入病房。分诊为ATS 3/4/5的患者占ICU收治患者的26.7%，与分诊为ATS 1/2的患者相比，他们等待就诊的时间更长，急诊部总住院时长更长，ICU住院时长更短，死亡率更低。与工作时间内的ICU收治情况相比，非工作时间的收治在任何测量结果上均无显著差异。在收治入ICU前被收治入病房的患者等待就诊的时间更长，急诊部住院时长也更长。
大多数患者在急诊部被恰当识别为需要收治入ICU，尽管约四分之一的患者分诊为ATS 3/4。先被收治入病房的患者往往比直接被收治入ICU的患者治疗结果更差。应确定预测ICU收治需求的因素，以支持临床决策。
