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. 2023 Jun 30;25(2):84-89.
doi: 10.1016/j.ccrj.2023.05.005. eCollection 2023 Jun.

Intensive care unit admission from the emergency department in the setting of National Emergency Access Targets

Jack D'Arcy  1 , Suzanne Doherty  1 , Luke Fletcher  1   2 , Ary Serpa Neto  1   2   3   4   5 , Daryl Jones  1   6   7
Affiliations

Intensive care unit admission from the emergency department in the setting of National Emergency Access Targets

Jack D'Arcy et al. Crit Care Resusc. .

Erratum in

  • Erratum for previously published articles.
    [No authors listed] [No authors listed] Crit Care Resusc. 2023 Oct 12;25(3):158. doi: 10.1016/j.ccrj.2023.09.001. eCollection 2023 Sep. Crit Care Resusc. 2023. PMID: 39726436 Free PMC article.

Abstract

Purpose: Since the introduction of National Emergency Access Targets (NEATs) in 2012 there has been little research examining patients admitted to the intensive care unit (ICU).We assessed differences in baseline characteristics and outcomes of patients admitted from the Emergency Department (ED) to the ICU within 4 hours compared with patients who were not.

Methods: This retrospective observational study included all adults (≥18 years old) admitted to the ICU from the ED of Austin Hospital, Melbourne, Australia, between 1 January 2017 and 31st December 2019 inclusive.

Results: 1544 patients were admitted from the ED to the ICU and 65% had an ED length of stay (EDLOS) > 4 hour. Such patients were more likely to be older, female, with less urgent triage category scores and lower illness severity. Sepsis and respiratory admission diagnoses, and winter presentations were significantly more prevalent in this group.After adjustment for confounders, patients with an EDLOS > 4 hours had lower hospital mortality; 8% v 21% (p = 0.029; OR, 1.62), shorter ICU length of stay 2.2 v 2.4 days (p = 0.043), but a longer hospital length of stay 6.2 v 6.8 days (p = < 0.001).

Conclusion: Almost two thirds of patients breached the NEAT of 4 hours. These patients were more likely to be older, female, admitted in winter with sepsis and respiratory diagnoses, and have lower illness severity and less urgent triage categories. NEAT breach was associated with reduced hospital mortality but an increased hospital length of stay.

Keywords: Access block; Admission; Emergency department (ED); Intensive care unit (ICU); Length of stay; NEAT.

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Figures

Fig. 1
Fig. 1
Kaplan Meier curve showing the difference in risk of death with time for patients admitted to the intensive care unit ＜4 h and ≧4 after arrival to the emergency department.
Fig. 2
Fig. 2
Figure showing non-liner relationship between risk of in-hospital mortality versus emergency department (ED) length of stay.
See this image and copyright information in PMC

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