Jason Nesbitt1, Tsuyoshi Mitarai2, Garrett K Chan3, Jennifer G Wilson2, Kian Niknam2, Matthew J R Nudelman4, Cristopher Cinkowski5, Michael A Kohn6. 1. Emergency Department, Stanford Health Care, Stanford, USA. Electronic address: jnesbitt@stanfordhealthcare.org. 2. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, USA. 3. Emergency Department, Stanford Health Care, Stanford, USA; Department of Emergency Medicine, Stanford University School of Medicine, Stanford, USA. 4. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, USA; Santa Clara Valley Medical Center, San Jose, USA. 5. Emergency Department, Stanford Health Care, Stanford, USA. 6. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, USA; Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, USA.
Abstract
STUDY HYPOTHESIS: We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED. METHODS: This was a retrospective before-after cohort study using electronic health record data at an academic medical center. We compared in-hospital mortality between the pre- and post-intervention periods and between non-prolonged (≤6 h) boarding time and prolonged (>6 h) boarding time. In-hospital mortality was stratified by illness severity (eccSOFA category) and adjusted using logistic regression. RESULTS: Severity-adjusted in-hospital mortality decreased from 12.8% pre-intervention to 12.3% post-intervention (-0.5% (95% CI, -3.1% to 2.1%), which was not statistically significant. This was despite a concurrent increase in ED and hospital crowding. The proportion of ECC patients downgraded to a lower level of care while still in the ED increased from 6.4% in the pre-intervention period to 17.0% in the post-intervention period. (+10.6%, 8.2% to 13.0%, p < 0.001). Severity-adjusted mortality was 12.8% in the non-prolonged group vs. 11.3% in the prolonged group (p = 0.331). CONCLUSIONS: During the post-intervention period, there was a significant increase in illness severity, hospital congestion, ED boarding time, and downgrades in the ED, but no significant change in mortality. These findings suggest that ECC nurses may improve the safety of boarding ICU patients in the ED. Longer ED boarding times were not associated with higher mortality in either the pre- or post-intervention periods.
STUDY HYPOTHESIS: We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED. METHODS: This was a retrospective before-after cohort study using electronic health record data at an academic medical center. We compared in-hospital mortality between the pre- and post-intervention periods and between non-prolonged (≤6 h) boarding time and prolonged (>6 h) boarding time. In-hospital mortality was stratified by illness severity (eccSOFA category) and adjusted using logistic regression. RESULTS: Severity-adjusted in-hospital mortality decreased from 12.8% pre-intervention to 12.3% post-intervention (-0.5% (95% CI, -3.1% to 2.1%), which was not statistically significant. This was despite a concurrent increase in ED and hospital crowding. The proportion of ECC patients downgraded to a lower level of care while still in the ED increased from 6.4% in the pre-intervention period to 17.0% in the post-intervention period. (+10.6%, 8.2% to 13.0%, p < 0.001). Severity-adjusted mortality was 12.8% in the non-prolonged group vs. 11.3% in the prolonged group (p = 0.331). CONCLUSIONS: During the post-intervention period, there was a significant increase in illness severity, hospital congestion, ED boarding time, and downgrades in the ED, but no significant change in mortality. These findings suggest that ECC nurses may improve the safety of boarding ICU patients in the ED. Longer ED boarding times were not associated with higher mortality in either the pre- or post-intervention periods.
Authors: Kevin Gardner; Alexandra June Gordon; Bryant Shannon; Jason Nesbitt; Jennifer G Wilson; Tsuyoshi Mitarai; Michael A Kohn Journal: J Am Coll Emerg Physicians Open Date: 2022-01-27