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A SENSE OF URGENCY: BOARDING OF CRITICAL CARE MEDICINE PATIENTS IN THE ED
Chest ; 162(4):A1117, 2022.
Article in English | EMBASE | ID: covidwho-2060772
ABSTRACT
SESSION TITLE SESSION TYPE PRESENTED ON

PURPOSE:

Critical Care Medicine (CCM) patients admitted to the Intensive Care Unit (ICU) but receiving ongoing care in the Emergency Department (ED) while awaiting an Intensive Care Unit (ICU) bed has been a growing area of concern. This has occurred more frequently during the COVID-19 global pandemic and resultant surge conditions at many hospitals.

METHODS:

This project presents a retrospective chart review and analysis, inclusive of 455 patients admitted to the medical ICU but receiving initial care while in the ED at Cleveland Clinic Akron General between October 1st 2020 and January 1st 2022. Linear regression analysis was performed to compare the association of boarding time (in total minutes after CCM assumed care,) ICU length of stay, and total ventilator days. Logistical regression analysis was used to investigate the association between boarding time and in-hospital mortality. Patients were further stratified into a subset of those with a diagnosis of Acute Respiratory Failure (ARF) in the setting of COVID-19 positivity.

RESULTS:

The total number of patients admitted under the ICU service was 454 (n=454). The total number of patients in a subset with ARF in the setting of COVID-19 positivity was 275 (n=275). Median age was 62.8 +/- 16.9 years. Mean ED boarding time was 462 +/- 1108 minutes. There was a statistically significant association between boarding time and ICU length of stay and boarding time and ventilator days. Linear regression analysis showed the variance between the ED boarding time and length of stay to be 0.024% (p-value 0.0116) and with ventilator days to be 0.023% (p-value 0.0401). Logistical regression analysis investigating an association between boarding time and in-hospital mortality did not reveal any significant relationship between these two variables. For the sub-group of ARF and COVID-19 positivity, there were no statistically significant associations.

CONCLUSIONS:

The overall impact of boarding time on ICU length of stay and in-hospital mortality was rather small, yet statistically significant for every one additional minute of boarding time, ICU length of stay increased by 0.024% and ventilator days increased by 0.023%. Forthcoming analysis will stratify patients based on acuity and risk-adjustment metrics, in order to further eliminate confounding factors which may influence boarding time. CLINICAL IMPLICATIONS The question of ED-CCM boarding is worthy of further examination in the setting of new and increased demands and strain on the national Critical Care Medicine infrastructure, as a result of the COVID-19 pandemic. This project aims to characterize the problem further and explore associated outcomes. This may provide the basis for further investigations, or targeted interventions, around the issue of EM-CCM boarding. DISCLOSURES No relevant relationships by Amit Diwakar No relevant relationships by Zachary Jerusalem No relevant relationships by Palak Rath No relevant relationships by Sterling Shriber
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2022 Document Type: Article