Influence of time-to-interventions for emergency department critical care patients on hospital mortality

J Emerg Nurs. 2007 Feb;33(1):6-13; quiz 90. doi: 10.1016/j.jen.2006.08.002. Epub 2006 Nov 30.

Abstract

Introduction: Patients seeking ED services require intensive interventions. Minimal literature exists on outcomes of mortality for ED patients admitted directly to ICU beds and outcomes of hospital stay. Wait times of the following interventions-time to first medication, first radiologic examination, first blood work, arrival in the emergency department to order for an ICU bed, and time of admission order to leaving the emergency department-were investigated for associations with hospital mortality.

Methods: This study was a quantitative, retrospective, non-experimental, exploratory, comparative analysis of secondary data.

Results: Nearly 54% of patients arrived by ambulance; 46% were walk-ins. Mean minutes to ICU admission order was 206.50; from order to leaving the emergency department, 93.56 minutes; and length of stay in the emergency department, 298 minutes. Mortality rates were higher for weekend admissions than for weekday admissions. An implication of logistic regression was that longer periods from order to leaving the emergency department affected hospital mortality rates.

Discussion: Mortality rate was more likely to increase the longer it took to leave the emergency department after an admission order. Further study on timeliness of ED interventions related to hospital outcomes may provide the information to revise practice. Using a system-wide database interfaced with an in-hospital system would facilitate the ability to do outcomes research.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Critical Care
  • Critical Illness*
  • Emergency Service, Hospital / statistics & numerical data*
  • Hospital Mortality*
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Middle Aged
  • Patient Admission / statistics & numerical data
  • Retrospective Studies
  • Time Factors