Triage and ongoing care for critically ill patients in the emergency department: Results from a national survey of emergency physicians Journal Article

Authors: Mathews, K. S.; Rodriguez, S. M.; Nelson, J. E.; Richardson, L. D.
Article Title: Triage and ongoing care for critically ill patients in the emergency department: Results from a national survey of emergency physicians
Abstract: INTRODUCTION: We conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs' perceptions about ongoing critical care delivery in the ED while awaiting ICU admission. METHODS: Through content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients "boarding" in the ED for >4-6 hours. RESULTS: We approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs' ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients. CONCLUSION: Patient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints.
Keywords: adult; controlled study; emergency ward; intensive care unit; cross-sectional study; emergency health service; perception; critically ill patient; emergency medicine; human; male; female; article; emergency physician; care behavior; patient volume
Journal Title: Western Journal of Emergency Medicine
Volume: 21
Issue: 2
ISSN: 1936-9018
Publisher: University of California  
Date Published: 2020-03-01
Start Page: 330
End Page: 335
Language: English
DOI: 10.5811/westjem.2019.11.43547
PUBMED: 32191190
PROVIDER: scopus
PMCID: PMC7081882
Notes: Article -- Export Date: 1 April 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Judith Eve Nelson
    56 Nelson