The Impact of an Early Intervention Team in the Emergency Department for ICU Boarders
Jayaprakash N, Pflaum-Carlson J, Gardner-Gray J, Hurst G, Kinni H, Coba V, and Rivers E. 331 The Impact of an Early Intervention Team in the Emergency Department for ICU Boarders. Ann Emerg Med 2019; 74(4):S130-S131.
Ann Emerg Med
Study Objectives: Models that address delivery of critical care in the emergency department (ED) during times of crowding and boarding include: the physical space of an ED-ICU; the critical care consultation model (both ED-centric and ICU-centric); the hybrid ED-ICU model and promoting rapid transfers to the ICU. The aim of this study was to assess the impact of an ED-centric critical care consultation service for ICU boarders, composed of board-certified emergency medicine and critical care physicians and referred to as the early intervention team (EIT). This is a service available at Henry Ford Hospital Monday through Friday, 2pm to 10pm. Methods: This was a retrospective observational study of adult patients (age >18 years) who presented to the emergency department at Henry Ford Hospital and were admitted to the ICU from February 5th, 2018 to February 4th, 2019. Those who received an EIT consultation were compared to those who received standard care without an EIT consultation. Patients were excluded if they were < 18 years of age and had a documented limitation of care (DNAR or advanced directive) prior to arrival to the ED. The study cohort was identified by an electronic data query of the electronic medical record. The primary outcome of interest was hospital length of stay (LOS). Secondary outcomes of interest included mortality, ICU LOS, ventilator free days and change in modified SOFA score. Results: Eight hundred and seventy patients met inclusion criteria. Of these, 546 had all the variables available to calculate a modified SOFA score resulting in 148 (Tests) who received an EIT consult and 398 (Controls) who did not. Following propensity matching using age, BMI and race, there was no difference in the primary outcome of interest: hospital LOS. Patients who received an EIT consultation had a longer median (IQR) ED boarding time, 8(4-14) hours vs. 4(2-6) hours, p < 0.001. Secondary analysis noted that there was a greater probability that the number of EIT cases increased as the quartile of baseline modified SOFA score increased, p < 0.001. At 24 hours, the modified SOFA scores were significantly higher than baseline for both test and control cases. However, at 48 hours the modified SOFA scores were still significantly higher than baseline for control cases, but not for test cases. Conclusion: This retrospective observational study identified that an ED-centric critical care consultation service with specialty trained physicians for ICU boarders, is utilized in patients with longer boarding times and higher severity of illness. This is associated with an improvement in the baseline modified SOFA score at 48 hours of hospitalization.