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. 2025 Jul 10;5(1):42.
doi: 10.1186/s44158-025-00262-x.

Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department

Felice Urso  1 , Daniele Catalano  2 , Ileana Suprina Petrovic  2 , Enrico Boero  2 , Paola Berchialla  3 , Luigi Vetrugno  4 , Daniela Silengo  2
Affiliations

Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department

Felice Urso et al. J Anesth Analg Crit Care. .

Abstract

Background: Boarding of critically ill patients in the emergency department (ED) is an emerging problem that increases mortality. We have developed a "CREM Unit (critical emergency medicine unit)" led by an anesthetist-intensivist who manages critical patients directly in the ED. This study aims to assess whether the CREM Unit is an effective model for mitigating the boarding of critical patients in the ED and the impact of this on mortality.

Method: This is a retrospective observational study. We collected all patients assigned to the CREM Unit from January 1, 2019, to December 31, 2021. As our primary endpoints, we calculated ED boarding rate and the impact of boarding time on mortality. As a secondary endpoint, we compared observed 28-day mortality to Simplified Acute Physiology Score (SAPS II) predicted mortality.

Results: Patients managed by the CREM unit were 127 in 2019, 181 in 2020, and 206 in 2021, with a clear upward trend, for a total of 514 patients (p < 0.001). Overall boarding rate was 13.9%, and length of stay in ED was not associated with an increased mortality (p = 0.399). Observed mortality was compared with expected mortality, estimated from the SAPS II score for a group of inpatients (n = 295). Moreover, the median value of SAPS II for inpatients was 54 (40.5-69.0), with an expected mortality of 55.3%, while the observed mortality was 36.8% (95% CI 31.9% to 42.1%, p < 0.0001).

Conclusions: Over the years, the number of patients assigned to the CREM Unit has grown steadily. These data suggest that the CREM Unit cares for a significant number of critically ill patients and could have a well-defined role both in keeping their boarding low and may contribute to reducing its impact on mortality.

Keywords: Anesthesiology; Critical care; Emergency medicine; Emergency service; Hospital mortality; Hospital/organization and administration; ICU; Lengths of stay.

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Conflict of interest statement

Declarations. Consent for publication: All authors have approved the manuscript for submission. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Model of intensive care unit (ICU) intensivist caring for critically ill patients outside the ICU
Fig. 2
Fig. 2
Flow diagram of the retrospective cohort showing the absolute frequency of patients managed by CREM Unit per year and the proportion of patients for whom boarding, mortality, and SAPS II were calculated
Fig. 3
Fig. 3
Absolute frequencies of emergency department (ED)-admitted patients (A) and absolute frequencies of CREM Unit-managed patients (B)
Fig. 4
Fig. 4
CREM Unit length of stay (LOS) shown as hours with their frequencies. A Overall patient data. B LOS stratified by year. C LOS stratified by unit of admission. D LOS stratified by unit of destination
Fig. 5
Fig. 5
Comparison of predicted and observed mortality as a percentage in our sample and 95% CI error bars
See this image and copyright information in PMC

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References

    1. Weingart SD, Sherwin RL, Emlet LL, Tawil I, Mayglothling J, Rittenberger JC (2013) ED intensivists and ED intensive care units. Am J Emerg Med 31(3):617–620. 10.1016/j.ajem.2012.10.015 - PubMed
    1. Mermiri M, Mavrovounis G, Chatzis D, Mpoutsikos I, Tsaroucha A, Dova M et al (2021) Critical emergency medicine and the resuscitative care unit. Acute and critical care 36(1):22–28. 10.4266/acc.2020.00521 - PMC - PubMed
    1. Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP, DELAY-ED study group (2007) Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 35(6):1477–1483. 10.1097/01.CCM.0000266585.74905.5A - PubMed
    1. Mohr NM, Wessman BT, Bassin B, Elie-Turenne MC, Ellender T, Emlet LL et al (2020) Boarding of critically ill patients in the emergency department. Crit Care Med 48(8):1180–1187. 10.1097/CCM.0000000000004385 - PMC - PubMed
    1. O’Callaghan DJ, Jayia P, Vaughan-Huxley E, Gribbon M, Templeton M, Skipworth JRA et al (2012) An observational study to determine the effect of delayed admission to the intensive care unit on patient outcome. Crit Care 16(5):R173. 10.1186/cc11650 - PMC - PubMed

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