Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

doi:10.1016/j.afjem.2021.07.006

. 2021 Dec;11(4):471-476.

doi: 10.1016/j.afjem.2021.07.006. Epub 2021 Nov 3.

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Mika Singh¹, Roshen Maharaj^{1

2}, Nikki Allorto³, Robert Wise^{4

5}

Affiliations

¹ Division of Emergency Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
² Department of Emergency Medicine, Livingstone Tertiary Hospital, Port Elizabeth, South Africa.
³ Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
⁴ Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
⁵ Adult Intensive Care Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.

PMID: 34804783
PMCID: PMC8581501
DOI: 10.1016/j.afjem.2021.07.006

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Mika Singh et al. Afr J Emerg Med. 2021 Dec.

. 2021 Dec;11(4):471-476.

doi: 10.1016/j.afjem.2021.07.006. Epub 2021 Nov 3.

Authors

Mika Singh¹, Roshen Maharaj^{1

2}, Nikki Allorto³, Robert Wise^{4

5}

Affiliations

¹ Division of Emergency Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
² Department of Emergency Medicine, Livingstone Tertiary Hospital, Port Elizabeth, South Africa.
³ Pietermaritzburg Burn Service, Pietermaritzburg Metropolitan Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
⁴ Discipline of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
⁵ Adult Intensive Care Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.

PMID: 34804783
PMCID: PMC8581501
DOI: 10.1016/j.afjem.2021.07.006

Abstract

Introduction: The objective was to describe the clinical characteristics, disease profile and outcome of patients referred from a regional hospital Emergency Centre (EC) to the Intensive Care Unit (ICU).

Methods: A retrospective review was performed using data extracted from the Integrated Critical Care Electronic Database (iCED). Data were extracted from the database with respect to patient characteristics, Society of Critical Care Medicine (SCCM) grading, and outcome of the ICU referral. Modified early warning scores (MEWS) were calculated from EC referral data.

Results: There were a total of 2187 referrals. Of these, 56.3% (1231/2187) were male. The mean age of referrals was 36 years. Of the referred patients, 41.5% (907/2187) were initially accepted for admission. A further 378 patients were accepted for admission after a follow up ICU review. Medical conditions accounted for the majority of patient referrals, followed by general surgery and trauma. Most patients initially accepted to ICU were classified as SCCM I and II and had a mean MEWS of 4. Almost half of the patients experienced a delay in admission, most commonly due to a lack of ICU bed availability. ICU mortality was 13.6% for patients admitted from the EC.

Discussion: The EC population referred to the ICU was young with a high burden of medical and trauma conditions. Decisions to accept patients to ICU are limited by available resources, and there was a need to apply ICU triage criteria. Delays in the transfer of ICU patients from the EC increase the workload and contribute to EC crowding.

Keywords: Critical care; Decision-making; Emergency centre; Intensive care unit.

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Conflict of interest statement

The authors declared no conflict of interest.

Figures

**Fig. 1**
Summary of ICU decision and outcomes of referrals.

**Fig. 2**
Reasons for accepted patients not being admitted to ICU.

See this image and copyright information in PMC

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[1] Simpson H., Clancy M., Goldfrad C., Rowan K. Admissions to intensive care units from emergency departments: a descriptive study. Emerg Med J. 2005;22(6):423–428. doi: 10.1136/emj.2003.005124. - DOI - PMC - PubMed

[2] Simpson H., Clancy M., Goldfrad C., Rowan K. Admissions to intensive care units from emergency departments: a descriptive study. Emerg Med J. 2005;22(6):423–428. doi: 10.1136/emj.2003.005124. - DOI - PMC - PubMed

[3] O' Connor G., Geary U., Moriarty J. Critical care in the emergency deaprtment. Eur J Emerg Med. 2009;16(6):296–300. doi: 10.1097/MEJ.0bo13e32831090bd. - DOI - PubMed

[4] O' Connor G., Geary U., Moriarty J. Critical care in the emergency deaprtment. Eur J Emerg Med. 2009;16(6):296–300. doi: 10.1097/MEJ.0bo13e32831090bd. - DOI - PubMed

[5] Fu K., Chen Y., Fan J., et al. Emergency department critical care unit for critically ill cardiovascular patients: an observational study. J Chin Med Assoc. 2017;80(4):233–244. doi: 10.1016/j.jcma.2016.09.008. - DOI - PubMed

[6] Fu K., Chen Y., Fan J., et al. Emergency department critical care unit for critically ill cardiovascular patients: an observational study. J Chin Med Assoc. 2017;80(4):233–244. doi: 10.1016/j.jcma.2016.09.008. - DOI - PubMed

[7] Herring A., Ginde A., Fahimi J. Increasing critical care admissions from U.S. Emergency Departments, 2001–2009. Crit Care Med. 2013;41(5):1197–1204. doi: 10.1097/CCM.0b013e31827c086f. - DOI - PMC - PubMed

[8] Herring A., Ginde A., Fahimi J. Increasing critical care admissions from U.S. Emergency Departments, 2001–2009. Crit Care Med. 2013;41(5):1197–1204. doi: 10.1097/CCM.0b013e31827c086f. - DOI - PMC - PubMed

[9] Adhikari N., Fowler R., Bhagwanjee S., Rubenfeld G. Critical care and the global burden of critical illness in adults. Lancet. 2010;376(9749):1339–1346. doi: 10.1016/S0140-6736(10)60446-1. - DOI - PMC - PubMed

[10] Adhikari N., Fowler R., Bhagwanjee S., Rubenfeld G. Critical care and the global burden of critical illness in adults. Lancet. 2010;376(9749):1339–1346. doi: 10.1016/S0140-6736(10)60446-1. - DOI - PMC - PubMed

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Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Affiliations

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Cited by

References

LinkOut - more resources

Full Text Sources