Characteristics and Outcomes of Implementing Emergency Department-based Intensive Care Units: A Scoping Review.

Abstract

Introduction: The prolonged stay of critically ill patients in the emergency department (ED) may lead to worse clinical outcomes. An emergency department (ED)-based intensive care unit (ICU) is one of the proposed solutions to deliver critical care in the ED. We thus aimed to characterize existent ED-ICU models and their reported association with clinical outcomes in critically ill adult patients.

Methods: We searched the Ovid MEDLINE database from inception to October 2, 2023. We included studies that report an ED-ICU structure, defined as a space capable of providing ICU-level care within or adjacent to the ED, and its characteristics. We excluded personnel-focused intervention (without the presence of a separated space) or a space without ICU-level care capability. We collected information on process measures, patient-related outcomes, and cost-related outcomes.

Results: We screened 2,824 studies, of which 125 full-text articles were assessed for eligibility and 31 studies were included in this scoping review. Studies reported on 14 ED-ICUs across seven countries, with capacities ranging from 3-17 beds. All ED-ICUs served early and ongoing critical care needs in the ED, including three distinct themes: short-stay; palliative care; and disaster-response ICUs. Implementing the ED-ICU was associated with decreased time to ICU-level care and reduced number of inpatient ICU admissions, but it was not consistently associated with improved survival.

Conclusion: Several ED-ICUs have been established around the world with different characteristics depending on local needs. Implementation of the ED-ICU may be associated with improved clinical outcomes and patient flow.