{"id":27286,"date":"2025-03-06T04:10:00","date_gmt":"2025-03-05T20:10:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27286"},"modified":"2025-03-06T05:57:40","modified_gmt":"2025-03-05T21:57:40","slug":"icu-management-practice-%e6%80%a5%e8%af%8a%e7%a7%91%e5%88%b0icu%e7%9a%84%e6%97%b6%e9%97%b4%e5%af%b9%e4%bd%8f%e9%99%a2%e7%97%85%e6%ad%bb%e7%8e%87%e7%9a%84%e5%bd%b1%e5%93%8d","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27286","title":{"rendered":"[ICU Management &#038; Practice]: \u6025\u8bca\u79d1\u5230ICU\u7684\u65f6\u95f4\u5bf9\u4f4f\u9662\u75c5\u6b7b\u7387\u7684\u5f71\u54cd"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Impact of Emergency Department to ICU Time on Hospital Mortality<\/h1>\n\n\n\n<ul>\n<li>In&nbsp;<a href=\"https:\/\/healthmanagement.org\/c\/icu\">ICU<\/a><\/li>\n\n\n\n<li>Mon, 18 Nov 2024<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/res.cloudinary.com\/healthmanagement-org\/image\/upload\/c_thumb,f_auto,fl_lossy,q_90\/v1731933987\/cw\/00128715_cw_image_wi_9b543e03f3b65fc8216d5aefde973492.webp\" alt=\"\"\/><\/figure>\n\n\n\n<p>What is the impact of prolonged emergency department (ED) length of stay (LOS), particularly ED-to-ICU time (from ED admission to ICU admission) and ED-boarding time (time between ICU admission decision and transfer), on hospital outcomes? Studies suggest prolonged ED-to-ICU times may increase ICU and hospital mortality, though findings are mixed.&nbsp;<\/p>\n\n\n\n<p>Some EDs have reduced mortality by integrating ICU beds. However, an Australasian study found no significant link between ED-to-ICU time and mortality, possibly due to methodological limitations. A 2019 study showed prolonged ED-to-ICU times increased mortality, especially for patients with high APACHE-IV probability scores. Critiques questioned the use of APACHE-IV scores, which might reflect treatment effects during ED stays or act as mediators rather than confounders. The study revealed a shift from a favourable to an unfavourable association between ED-to-ICU time and mortality after adjusting for APACHE-IV probability, supporting its use as an early indicator of clinical condition.<\/p>\n\n\n\n<p>To address these concerns, a larger retrospective study was conducted, stratifying by hospital type (academic vs. nonacademic) and using the ED-triage score as a potentially earlier and more relevant measure of illness severity compared to the APACHE-IV probability.<\/p>\n\n\n\n<p>The study analysed data from the Dutch National Intensive Care Evaluation registry (2009\u20132020), focusing on patients directly admitted from the ED to the ICU across four academic and eight non-academic teaching hospitals. Using multivariable regression, the researchers estimated odds ratios (ORs) for mortality associated with ED-to-ICU time. The study included 28,455 patients with a median ED-to-ICU time of 1.9 hours.&nbsp;<\/p>\n\n\n\n<p>No significant association was found between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability. Among patients with an APACHE-IV probability &gt;55.4% and ED-to-ICU times &gt;3.4 hours, the adjusted odds ratio for mortality was 1.24 compared to those with ED-to-ICU times &lt;1.1 hours. Adjusted ORs for increasing ED-to-ICU times were significantly higher for ED-to-ICU times of 1.6\u20132.3 hours, 2.3\u20133.4 hours and &gt;3.4 hours using APACHE-IV adjustments. After adjusting for ED-triage scores, the OR for times &gt;3.4 hours was 0.98. No significant associations were observed with APACHE-IV adjustments. After adjusting for ED-triage scores, all ORs were &lt;1.0 for increasing ED-to-ICU times.<\/p>\n\n\n\n<p>Overall, prolonged ED-to-ICU times had different impacts on mortality across hospital types and patient severity, highlighting the complexity of these associations. In academic hospitals, prolonged ED-to-ICU time was linked to increased hospital mortality in patients with the highest APACHE-IV probability. No significant or consistent unfavourable associations were observed in lower-risk groups or in nonacademic teaching hospitals. After adjusting and stratifying by ED-triage scores, the association between longer ED-to-ICU times and higher mortality was no longer evident.<\/p>\n\n\n\n<p>Source:&nbsp;<a href=\"https:\/\/journals.lww.com\/ccmjournal\/fulltext\/2024\/12000\/emergency_department_triage,_transfer_times,_and.6.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Critical Care Medicine<\/a><br \/>Image Credit: iStock&nbsp;<br \/>&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">References:<\/h4>\n\n\n\n<p>van Herwerden MC et al. (2024)&nbsp;<a href=\"https:\/\/journals.lww.com\/ccmjournal\/fulltext\/2024\/12000\/emergency_department_triage,_transfer_times,_and.6.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study.&nbsp;<\/a>Crit Care Med. 52(12):1856\u201365.&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Impact of Emergency Department to ICU Time on Hospital  [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27286"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27286"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27286\/revisions"}],"predecessor-version":[{"id":27287,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27286\/revisions\/27287"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27286"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27286"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}