Quincy K Tran1, James O'Connor2, Roumen Vesselinov3, Daniel Haase1, Rebecca Duncan4, Ashley Aitken5, Jeffrey H Rea1, Kevin Jones1, Theresa Dinardo5, Thomas Scalea2, Jay Menaker2, Lewis Rubinson6. 1. Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland. 2. The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 3. Department of Epidemiology and Public Health, University of Maryland at Baltimore, Baltimore, Maryland. 4. The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland. 5. University of Maryland Medical Center, Baltimore, Maryland. 6. The R. Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland; Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Transfer delays of critically ill patients from other hospitals' emergency departments (EDs) to an appropriate referral hospital's intensive care unit (ICU) are associated with poor outcomes. OBJECTIVES: We hypothesized that an innovative Critical Care Resuscitation Unit (CCRU) would be associated with improved outcomes by reducing transfer times to a quaternary care center and times to interventions for ED patients with critical illnesses. METHODS: This pre-post analysis compared 3 groups of patients: a CCRU group (patients transferred to the CCRU during its first year [July 2013 to June 2014]), a 2011-Control group (patients transferred to any ICU between July 2011 and June 2012), and a 2013-Control group (patients transferred to other ICUs between July 2013 and June 2014). The primary outcome was time from transfer request to ICU arrival. Secondary outcomes were the interval between ICU arrival to the operating room and in-hospital mortality. RESULTS: We analyzed 1565 patients (644 in the CCRU, 574 in the 2011-Control, and 347 in 2013-Control groups). The median time from transfer request to ICU arrival for CCRU patients was 108 min (interquartile range [IQR] 74-166 min) compared with 158 min (IQR 111-252 min) for the 2011-Control and 185 min (IQR 122-283 min) for the 2013-Control groups (p < 0.01). The median arrival-to-urgent operation for the CCRU group was 220 min (IQR 120-429 min) versus 439 min (IQR 290-645 min) and 356 min (IQR 268-575 min; p < 0.026) for the 2011-Control and 2013-Control groups, respectively. After adjustment with clinical factors, transfer to the CCRU was associated with lower mortality (odds ratio 0.64 [95% confidence interval 0.44-0.93], p = 0.019) in multivariable logistic regression. CONCLUSION: The CCRU, which decreased time from outside ED's transfer request to referral ICU arrival, was associated with lower mortality likelihood. Resuscitation units analogous to the CCRU, which transfer resource-intensive patients from EDs faster, may improve patient outcomes.
BACKGROUND:Transfer delays of critically illpatients from other hospitals' emergency departments (EDs) to an appropriate referral hospital's intensive care unit (ICU) are associated with poor outcomes. OBJECTIVES: We hypothesized that an innovative Critical Care Resuscitation Unit (CCRU) would be associated with improved outcomes by reducing transfer times to a quaternary care center and times to interventions for ED patients with critical illnesses. METHODS: This pre-post analysis compared 3 groups of patients: a CCRU group (patients transferred to the CCRU during its first year [July 2013 to June 2014]), a 2011-Control group (patients transferred to any ICU between July 2011 and June 2012), and a 2013-Control group (patients transferred to other ICUs between July 2013 and June 2014). The primary outcome was time from transfer request to ICU arrival. Secondary outcomes were the interval between ICU arrival to the operating room and in-hospital mortality. RESULTS: We analyzed 1565 patients (644 in the CCRU, 574 in the 2011-Control, and 347 in 2013-Control groups). The median time from transfer request to ICU arrival for CCRU patients was 108 min (interquartile range [IQR] 74-166 min) compared with 158 min (IQR 111-252 min) for the 2011-Control and 185 min (IQR 122-283 min) for the 2013-Control groups (p < 0.01). The median arrival-to-urgent operation for the CCRU group was 220 min (IQR 120-429 min) versus 439 min (IQR 290-645 min) and 356 min (IQR 268-575 min; p < 0.026) for the 2011-Control and 2013-Control groups, respectively. After adjustment with clinical factors, transfer to the CCRU was associated with lower mortality (odds ratio 0.64 [95% confidence interval 0.44-0.93], p = 0.019) in multivariable logistic regression. CONCLUSION: The CCRU, which decreased time from outside ED's transfer request to referral ICU arrival, was associated with lower mortality likelihood. Resuscitation units analogous to the CCRU, which transfer resource-intensive patients from EDs faster, may improve patient outcomes.
Authors: William Gilliam; Jackson F Barr; Brandon Bruns; Brandon Cave; Jordan Mitchell; Tina Nguyen; Jamie Palmer; Mark Rose; Safura Tanveer; Chris Yum; Quincy K Tran Journal: World J Emerg Med Date: 2021
Authors: Brandon Cave; Daniel Najafali; William Gilliam; Jackson F Barr; Christian Cain; Chris Yum; Jamie Palmer; Safura Tanveer; Emily Esposito; Quincy K Tran Journal: Crit Care Res Pract Date: 2022-04-15
Authors: Quincy K Tran; Sagar Dave; Daniel J Haase; Laura Tiffany; Shannon Gaasch; Wan-Tsu W Chang; Kevin Jones; Matthew J Kole; Aaron Wessell; Gary Schwartzbauer; Thomas M Scalea; Jay Menaker Journal: West J Emerg Med Date: 2021-01-12
Authors: Silvia Solà-Muñoz; Youcef Azeli; Josep Trenado; Xavier Jiménez; Roger Bisbal; Àngels López; Jorge Morales; Xaime García; Bernat Sánchez; José Fernández; Maria Ángeles Soto; Yolanda Ferreres; Cristina Cantero; Javier Jacob Journal: Int J Qual Health Care Date: 2022-03-28 Impact factor: 2.038
Authors: Elizabeth Powell; Iana Sahadzic; Daniel Najafali; Emilie Berman; Katie Andersen; Leenah Z Afridi; Zoe Gasparotti; Erin Niles; Jeffrey Rea; Thomas Scalea; Daniel J Haase; Quincy K Tran Journal: Crit Care Res Pract Date: 2022-07-19