Division of Pulmonary and Critical Care Medicine, Baylor University Medical Center, Dallas, TX, USA.
Biostatistics Department, Baylor Scott & White Research Institute, Dallas, TX, USA.
Intern Emerg Med. 2023 Sep;18(6):1789-1796. doi: 10.1007/s11739-023-03265-0. Epub 2023 Apr 19.
Emergency department patient boarding is associated with hospital mortality and increased hospital length of stay. The objective of the present study is to describe the impact of deploying an Intensive Care team in the ED and its association with sepsis mortality and ICU length of stay. Patients admitted to ICU through the ED with an ICD-10 CM diagnosis of sepsis were included. Preintervention and postintervention phases included 4 and 15 months, respectively. Sepsis time zero, SEP-1 compliance, and lag time from time zero to antibiotic administration were compared. Outcomes of interest were mortality and ICU LOS. 1021 septic patients were included. Sixty-six percent fulfilled compliance with 3 h SEP-1 bundle. Lag time from time zero to antibiotic administration was 75 min. Multivariate analysis showed no association between ICU team in the ED and hospital mortality (Log OR 0.94, CI 0.67-1.34; p = 0.73). The ICU team in the ED was associated with prolonged ICU LOS (Log OR 1.21, CI 1.13-1.30; p < 0.01). Septic shock and ED boarding time were associated with prolonged ICU LOS. Compliance with SEP-1 bundle was associated with its reduction. Implementation of an ICU team in the ED for the treatment of septic patients during high volume hospitalizations is not associated with a reduction of mortality or ICU LOS.
急诊科患者滞留与医院死亡率和住院时间延长有关。本研究的目的是描述在急诊科部署重症监护团队的影响及其与脓毒症死亡率和 ICU 住院时间的关系。通过急诊科收治 ICU 并符合 ICD-10 CM 脓毒症诊断的患者纳入研究。干预前和干预后分别为 4 个月和 15 个月。比较了脓毒症时间零、SEP-1 依从性和从时间零到抗生素给药的延迟时间。感兴趣的结果是死亡率和 ICU 住院时间。共纳入 1021 例脓毒症患者。66%的患者符合 3 小时 SEP-1 捆绑包的依从性。从时间零到抗生素给药的延迟时间为 75 分钟。多变量分析显示，急诊科 ICU 团队与医院死亡率之间无关联（Log OR 0.94，CI 0.67-1.34；p=0.73）。急诊科 ICU 团队与 ICU 住院时间延长相关（Log OR 1.21，CI 1.13-1.30；p<0.01）。脓毒性休克和急诊科滞留时间与 ICU 住院时间延长相关。SEP-1 捆绑包的依从性与 ICU 住院时间的缩短有关。在高容量住院期间为治疗脓毒症患者在急诊科实施 ICU 团队与死亡率或 ICU 住院时间的缩短无关。
