University of Oulu

Aitavaara-Anttila M, Liisanantti JH,Raatiniemi L, Ohtonen P, Ala-Kokko T. Factors related todelayed intensive care unit admission from emergency department—A retrospective cohort study. Acta Anaesthesiol Scand. 2019;63:939–946. https://doi.org/10.1111/aas.13355

Factors related to delayed intensive care unit admission from emergency department : a retrospective cohort study

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Author: Aitavaara‐Anttila, Mia1; Liisanantti, Janne H.1; Raatiniemi, Lasse1;
Organizations: 1Division of Intensive Care Medicine, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe2019100931975
Language: English
Published: John Wiley & Sons, 2019
Publish Date: 2020-03-18
Description:

Abstract

Background: The delays in transferring patients from emergency department (ED) to intensive care unit (ICU) are known to be linked with several adverse events, including prolonged ICU stay and increased hospital mortality. The factors associated with delayed ICU admission include shortage of ICU beds, organizational factors, ED overcrowding, and patient‐related factors, including sepsis as admission diagnosis. The aim of this study was to examine ED‐related factors associated with prolonged ED stay.

Methods: The study population consisted of adult patients admitted (n = 479) from ED to ICU between 31 May 2016 and 19 March 2017 in Oulu University Hospital. A patient’s ED length of stay (LOS) exceeding 180 minutes was considered delayed.

Results: Most of the patients (380, 79.3%) were admitted to the ICU within 3 hours of hospital admission. In a logistic regression analysis, odds ratios (ORs) for ED LOS > 180 minutes were as follows: for Glasgow Coma Scale score > 9, 2.73 (1.39–5.32); for thrombocytes < 100 × 109/mmol, 6.69 (2.32–19.26); for absence of pre‐arrival notification, 5.27 (3.04–9.14); and for radiological examination, 3.95 (1.72‐9.10). Trauma and intoxicated patients had shorter ED LOS while patients with medical conditions had more often prolonged admissions.

Conclusion: The delays in ICU admissions were linked to therapeutic and diagnostic procedures and absence of pre‐arrival notification. Patients were admitted to the ICU on the basis of diagnosis instead of clinical risk. However, the delays were not associated with worsening outcome, which indicates that sufficient care can be provided at the ED while the ICU admission is pending.

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Series: Acta anaesthesiologica Scandinavica
ISSN: 0001-5172
ISSN-E: 1399-6576
ISSN-L: 0001-5172
Volume: 63
Issue: 7
Pages: 939 - 946
DOI: 10.1111/aas.13355
OADOI: https://oadoi.org/10.1111/aas.13355
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Copyright information: © 2019 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Aitavaara-Anttila M, Liisanantti JH,Raatiniemi L, Ohtonen P, Ala-Kokko T. Factors related todelayed intensive care unit admission from emergency department—A retrospective cohort study. Acta Anaesthesiol Scand. 2019;63:939–946. https://doi.org/10.1111/aas.13355, which has been published in final form at https://doi.org/10.1111/aas.13355. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.