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Rate of patients going from ED to ICU rises

Wednesday May 15, 2013
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ICU admissions from the ED increased by almost 50% between 2002 and 2009, according to a study.

"The increase might be the result of an older, sicker population that needs more care," Peter Mullins, MA, the study’s lead author and a researcher with the George Washington University School of Public Health and Health Services, said in a news release.

Mullins and his colleagues conducted the study by using data from the National Hospital Ambulatory Care Survey, a sample of hospital-based EDs in the United States during a seven-year period. They found that ICU admissions jumped from 2.79 million in 2002-03 to 4.14 million in 2008-09. During the same time frame, overall ED admissions grew by only 5.8%.

Other key findings of the study, which was published in the May issue of Academic Emergency Medicine:

• ICU admissions grew the most among patients 85 and older, increasing 25% every two years during the study period.

• Utilization of tests and services provided to ED patients on their way to the ICU also increased, with the largest rise occurring in CT or MRI tests. The rate of those tests provided to patients still in the ED increased from 16.4% to 37.4%.

• The most common reasons for ICU admissions were symptoms that can signal life-threatening conditions such as myocardial infarction.

• On average patients waited five hours in the ED before getting to the ICU.

Additional research is needed to find ways to keep critically ill patients from facing long waits in crowded EDs, said co-author Jesse Pines, MD, MBA, MSCE, a practicing emergency physician and an associate professor of emergency medicine and health policy at SPHHS.

"Studies have shown that the longer ICU patients stay in the emergency department, the more likely they are to die in the hospital," Pines said. "Better coordination between the emergency department and ICU staff might help speed transfers and prevent complications caused by long emergency department waits."

Another key question that merits future consideration is whether there will be enough ICU capacity to accommodate the growing number of patients, particularly the oldest, the researchers said.

Read the study abstract: http://onlinelibrary.wiley.com/doi/10.1111/acem.12134/abstract.