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ED-to-ICU Transfer Sees Huge Increase

MANAGED CARE July 2013. © MediMedia USA
News & Commentary

ED-to-ICU Transfer Sees Huge Increase

Admissions to intensive care units (ICUs) from emergency departments (EDs) rose by nearly 50% between 2002 and 2009, according to a study in the May issue of Academic Emergency Medicine.

The authors of “National Growth in Intensive Care Unit Admissions from Emergency Departments in the United States from 2002 to 2009” add that nonwhites and Medicaid enrollees are over-represented:

“Higher rates of general ED and ICU use in these groups may be a symptom of less access to primary care and preventive services, contributing to both increased use of the ED and increasingly higher severity presentations requiring ICU-level care.”

Researchers used data from the National Hospital Ambulatory Care Survey, a national sample of hospital-based EDs. They looked at 4,267 patients who moved from the ED to the ICU, a sample representing over 14.5 million ED encounters during that time.

“Over the study period, ICU admissions from EDs increased from 2.79 million in 2002/2003 to 4.14 million in 2008/2009, an absolute increase of 48.8% and a mean biennial increase of 14.2%,” the study states. “By comparison, overall ED visits increased a mean of 5.8% per biennial period.”

The most frequent reasons for admission were chest pain, shortness of breath, and abdominal pain. The most frequent diagnoses were chest pain, congestive heart failure, and pneumonia.

“Despite this, the top 10 complaints and diagnoses [made up only] 50% and 35%, respectively, of all ICU admissions. This demonstrates the heterogeneity of critically ill patients cared for in ED settings, further underscoring the need for critical care training in emergency medicine residency and beyond.”

Another issue is that patients admitted to the ICU from the ED also underwent more tests, especially CTs and MRIs “which increased from 16.8% in 2002/2003 to 37.4% in 2008/2009, a 6.9% mean biennial increase.”

Patients making such a transfer spend an average of five hours in the ED, the researchers find.

“This finding may suggest that delays in transfer from ED to ICU may be more dependent upon the availability of ICU beds than the level of resource utilization in the ED.”