Boarding of critically Ill patients in the emergency department.

Autor: Mohr NM; Department of Emergency Medicine and Department of Anesthesia University of Iowa Carver College of Medicine Iowa City IA., Wessman BT; Department of Anesthesiology and Department of Emergency Medicine Washington University School of Medicine St. Louis MO., Bassin B; Department of Emergency Medicine Division of Critical Care University of Michigan Ann Arbor MI., Elie-Turenne MC; Department of Emergency Medicine and Department of Medicine Critical Care Medicine Palliative and Hospice Medicine University of Florida Gainesville FL., Ellender T; Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN., Emlet LL; Department of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh PA., Ginsberg Z; Kettering Health System Department of Emergency & Critical Care Medicine Dayton OH., Gunnerson K; Department of Emergency Medicine Division of Critical Care University of Michigan Ann Arbor MI., Jones KM; Program in Trauma R. Adams Cowley Shock Trauma Center, Department of Emergency Medicine University of Maryland School of Medicine Baltimore MA., Kram B; Department of Pharmacy Duke University Hospital Durham NC., Marcolini E; Section of Emergency Medicine Department of Medicine Geisel School of Medicine at Dartmouth Hanover NH., Rudy S; Department of Nursing Vanderbilt University Nashville TN.
Jazyk: angličtina
Zdroj: Journal of the American College of Emergency Physicians open [J Am Coll Emerg Physicians Open] 2020 Jul 17; Vol. 1 (4), pp. 423-431. Date of Electronic Publication: 2020 Jul 17 (Print Publication: 2020).
DOI: 10.1002/emp2.12107
Abstrakt: Objectives: Emergency department boarding is the practice of caring for admitted patients in the emergency department after hospital admission, and boarding has been a growing problem in the United States. Boarding of the critically ill has achieved specific attention because of its association with poor clinical outcomes. Accordingly, the Society of Critical Care Medicine and the American College of Emergency Physicians convened a Task Force to understand the implications of emergency department boarding of the critically ill. The objective of this article is to review the U.S. literature on (1) the frequency of emergency department boarding among the critically ill, (2) the outcomes associated with critical care patient boarding, and (3) local strategies developed to mitigate the impact of emergency department critical care boarding on patient outcomes.
Data Sources and Study Selection: Review article.
Data Extraction and Data Synthesis: Emergency department-based boarding of the critically ill patient is common, but no nationally representative frequency estimates has been reported. Boarding literature is limited by variation in the definitions used for boarding and variation in the facilities studied (boarding ranges from 2% to 88% of ICU admissions). Prolonged boarding in the emergency department has been associated with longer duration of mechanical ventilation, longer ICU and hospital length of stay, and higher mortality. Health systems have developed multiple mitigation strategies to address emergency department boarding of critically ill patients, including emergency department-based interventions, hospital-based interventions, and emergency department-based resuscitation care units.
Conclusions: Emergency department boarding of critically ill patients was common and was associated with worse clinical outcomes. Health systems have generated a number of strategies to mitigate these effects. A definition for emergency department boarding is proposed. Future work should establish formal criteria for analysis and benchmarking of emergency department-based boarding overall, with subsequent efforts focused on developing and reporting innovative strategies that improve clinical outcomes of critically ill patients boarded in the emergency department.
(© 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.)
Databáze: MEDLINE
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