Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review
Introduction: The prolonged stay of critically ill patients in the emergency department (ED) may lead to worse clinical outcomes. An emergency department (ED)-based intensive care unit (ICU) is one of the proposed solutions to deliver critical care in the ED. We thus aimed to characterize existent E...
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2024-11-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/1t3887sw |
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| author | Jutamas Saoraya Liran Shechtman Paweenuch Bootjeamjai Khrongwong Musikatavorn Federico Angriman |
| author_facet | Jutamas Saoraya Liran Shechtman Paweenuch Bootjeamjai Khrongwong Musikatavorn Federico Angriman |
| author_sort | Jutamas Saoraya |
| collection | DOAJ |
| description | Introduction: The prolonged stay of critically ill patients in the emergency department (ED) may lead to worse clinical outcomes. An emergency department (ED)-based intensive care unit (ICU) is one of the proposed solutions to deliver critical care in the ED. We thus aimed to characterize existent ED-ICU models and their reported association with clinical outcomes in critically ill adult patients. Methods: We searched the Ovid MEDLINE database from inception to October 2, 2023. We included studies that report an ED-ICU structure, defined as a space capable of providing ICU-level care within or adjacent to the ED, and its characteristics. We excluded personnel-focused intervention (without the presence of a separated space) or a space without ICU-level care capability. We collected information on process measures, patient-related outcomes, and cost-related outcomes. Results: We screened 2,824 studies, of which 125 full-text articles were assessed for eligibility and 31 studies were included in this scoping review. Studies reported on 14 ED-ICUs across seven countries, with capacities ranging from 3–17 beds. All ED-ICUs served early and ongoing critical care needs in the ED, including three distinct themes: short-stay; palliative care; and disaster-response ICUs. Implementing the ED-ICU was associated with decreased time to ICU-level care and reduced number of inpatient ICU admissions, but it was not consistently associated with improved survival. Conclusion: Several ED-ICUs have been established around the world with different characteristics depending on local needs. Implementation of the ED-ICU may be associated with improved clinical outcomes and patient flow. |
| format | Article |
| id | doaj-art-235a719be4c54cb6a831b32775a1dab6 |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-235a719be4c54cb6a831b32775a1dab62025-02-07T16:29:04ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182024-11-01261788510.5811/westjem.2487424874Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping ReviewJutamas Saoraya0Liran Shechtman1Paweenuch Bootjeamjai2Khrongwong Musikatavorn3Federico Angriman4Chulalongkorn University, Faculty of Medicine, Division of Academic Affairs, Bangkok, ThailandUniversity of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, CanadaChulalongkorn University, Department of Anesthesiology, Bangkok, ThailandChulalongkorn University, Faculty of Medicine, Department of Emergency Medicine, Bangkok, ThailandUniversity of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, CanadaIntroduction: The prolonged stay of critically ill patients in the emergency department (ED) may lead to worse clinical outcomes. An emergency department (ED)-based intensive care unit (ICU) is one of the proposed solutions to deliver critical care in the ED. We thus aimed to characterize existent ED-ICU models and their reported association with clinical outcomes in critically ill adult patients. Methods: We searched the Ovid MEDLINE database from inception to October 2, 2023. We included studies that report an ED-ICU structure, defined as a space capable of providing ICU-level care within or adjacent to the ED, and its characteristics. We excluded personnel-focused intervention (without the presence of a separated space) or a space without ICU-level care capability. We collected information on process measures, patient-related outcomes, and cost-related outcomes. Results: We screened 2,824 studies, of which 125 full-text articles were assessed for eligibility and 31 studies were included in this scoping review. Studies reported on 14 ED-ICUs across seven countries, with capacities ranging from 3–17 beds. All ED-ICUs served early and ongoing critical care needs in the ED, including three distinct themes: short-stay; palliative care; and disaster-response ICUs. Implementing the ED-ICU was associated with decreased time to ICU-level care and reduced number of inpatient ICU admissions, but it was not consistently associated with improved survival. Conclusion: Several ED-ICUs have been established around the world with different characteristics depending on local needs. Implementation of the ED-ICU may be associated with improved clinical outcomes and patient flow.https://escholarship.org/uc/item/1t3887sw |
| spellingShingle | Jutamas Saoraya Liran Shechtman Paweenuch Bootjeamjai Khrongwong Musikatavorn Federico Angriman Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review Western Journal of Emergency Medicine |
| title | Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review |
| title_full | Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review |
| title_fullStr | Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review |
| title_full_unstemmed | Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review |
| title_short | Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review |
| title_sort | characteristics and outcomes of implementing emergency department based intensive care units a scoping review |
| url | https://escholarship.org/uc/item/1t3887sw |
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