评估基于急诊科(ED)的重症监护咨询服务的影响,假设早期会诊可以缩短住院时间(LOS).
方法:2018年2月至2020年的回顾性观察性研究。
方法:城市学术四级转诊中心。
方法:从ED进入ICU的18岁以上的成年患者。排除标准包括年龄小于18岁,不要复苏/不要在抵达前记录插管,概述护理局限性的高级指令,无法计算基线改良序贯器官衰竭评估(mSOFA)评分。
方法:由初级急诊医师发起的早期干预团队(EIT)进行的基于ED的重症监护咨询与常规实践进行比较。
方法:主要结果是医院LOS,次要结局是医院死亡率,ICULOS,无呼吸机日,以及mSOFA的变化。
结果:共有1,764例患者符合纳入标准,其中492人(27.9%)通过EIT评估。最终分析,不包括没有基线mSOFA评分的人,限于1699名患者,476在EIT咨询小组,和1,223常规护理组。EIT咨询组的基线mSOFA评分(±sd)较高,为3.6(±2.4),而常规护理组为2.6(±2.0)。在倾向得分匹配后,主要结局没有差异:EIT咨询组的中位(四分位距[IQR])LOS为7.0天(4.0-13.0d),而常规治疗组的中位(IQR)LOS为7.0天(4.0-13.0d),p=0.64。EIT咨询组的中位(IQR)登机时间为8.0(5.0-15.0),是常规护理4.0(3.0-7.0)的两倍,p<0.001。
结论:基于ED的重症监护咨询模式对医院LOS没有影响。该模型用于ED,而EIT则用于疾病严重程度更高,ED登机时间更长的危重病人。
Evaluate the impact of an emergency department (ED)-based critical care consultation service, hypothesizing early consultation results in shorter hospital length of stay (LOS).
METHODS: Retrospective observational study from February 2018 to 2020.
METHODS: An urban academic quaternary referral center.
METHODS: Adult patients greater than or equal to 18 years admitted to the ICU from the ED. Exclusion criteria included age less than 18 years, do not resuscitate/do not intubate documented prior to arrival, advanced directives outlining limitations of care, and inability to calculate baseline modified Sequential Organ Failure Assessment (mSOFA) score.
METHODS: ED-based critical care consultation by an early intervention team (EIT) initiated by the primary emergency medicine physician compared with usual practice.
METHODS: The primary outcome was hospital LOS, and secondary outcomes were hospital mortality, ICU LOS, ventilator-free days, and change in the mSOFA.
RESULTS: A total 1,764 patients met inclusion criteria, of which 492 (27.9%) were evaluated by EIT. Final analysis, excluding those without baseline mSOFA score, limited to 1,699 patients, 476 in EIT consultation group, and 1,223 in usual care group. Baseline mSOFA scores (±sd) were higher in the EIT consultation group at 3.6 (±2.4) versus 2.6 (±2.0) in the usual care group. After propensity score matching, there was no difference in the primary outcome: EIT consultation group had a median (interquartile range [IQR]) LOS of 7.0 days (4.0-13.0 d) compared with the usual care group median (IQR) LOS of 7.0 days (4.0-13.0 d), p = 0.64. The median (IQR) boarding time was twice as long subjects in the EIT consultation group at 8.0 (5.0-15.0) compared with 4.0 (3.0-7.0) usual care, p < 0.001.
CONCLUSIONS: An ED-based critical care consultation model did not impact hospital LOS. This model was used in the ED and the EIT cared for critically ill patients with higher severity of illness and longer ED boarding times.