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Effect of emergency critical care nurses and emergency department boarding time on in-hospital mortality in critically ill patients
- Source :
- The American journal of emergency medicine. 41
- Publication Year :
- 2020
-
Abstract
- We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED.This was a retrospective before-after cohort study using electronic health record data at an academic medical center. We compared in-hospital mortality between the pre- and post-intervention periods and between non-prolonged (≤6 h) boarding time and prolonged (6 h) boarding time. In-hospital mortality was stratified by illness severity (eccSOFA category) and adjusted using logistic regression.Severity-adjusted in-hospital mortality decreased from 12.8% pre-intervention to 12.3% post-intervention (-0.5% (95% CI, -3.1% to 2.1%), which was not statistically significant. This was despite a concurrent increase in ED and hospital crowding. The proportion of ECC patients downgraded to a lower level of care while still in the ED increased from 6.4% in the pre-intervention period to 17.0% in the post-intervention period. (+10.6%, 8.2% to 13.0%, p 0.001). Severity-adjusted mortality was 12.8% in the non-prolonged group vs. 11.3% in the prolonged group (p = 0.331).During the post-intervention period, there was a significant increase in illness severity, hospital congestion, ED boarding time, and downgrades in the ED, but no significant change in mortality. These findings suggest that ECC nurses may improve the safety of boarding ICU patients in the ED. Longer ED boarding times were not associated with higher mortality in either the pre- or post-intervention periods.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Critical Illness
Emergency Nursing
Logistic regression
Critical Care Nursing
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Critical care nursing
medicine
Humans
Hospital Mortality
Aged
Retrospective Studies
Aged, 80 and over
In hospital mortality
Critically ill
business.industry
030208 emergency & critical care medicine
General Medicine
Emergency department
Middle Aged
Crowding
Emergency medicine
Emergency Medicine
Female
Level of care
business
Emergency Service, Hospital
Cohort study
Subjects
Details
- ISSN :
- 15328171
- Volume :
- 41
- Database :
- OpenAIRE
- Journal :
- The American journal of emergency medicine
- Accession number :
- edsair.doi.dedup.....7dae81f92664780ab57a28b817ce35c9