Outcomes of critically ill patients: Based on duration of emergency department stay

Objective We hypothesized that critically ill patients who remain in the ED for more than 24 hours experience worse outcomes and longer lengths of stay than those transferred to the medical intensive care unit (MICU) within 24 hours. Methods Medical records were examined of all patients admitted to the MICU directly from the ED of a 325-bed community teaching hospital between 2001 and 2002. Results Of 443 patients, 104 remained in the ED for 24 hours or longer (ED≥24) before being transferred to the MICU. There were no significant differences in demographic characteristics of the 339 who were in the ED for less than 24 hours (ED<24) as compared with ED≥24. APACHE II scores were 18.9 ± 1.0 for a random sample of ED<24 and 20.5 ± 0.9 for ED≥24 (P = .2). Lengths of hospital stay were 10.9 ± 0.8 days for ED<24 and 9.8 ± 0.9 days for ED≥24 (P = .7). Mortality rates were 26.8% for ED<24 and 26.9% for ED≥24 (P = .5). Conclusions These data suggest that outcomes of critically ill patients transferred from the ED to our MICU within 24 hours were not better than those who remained in the ED for longer durations. Larger studies are required to examine this hypothesis.