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.
\nMethods: 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.
\nResults: 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.
\nConclusion: 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.
","language":"eng","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"emergency department"},{"word":"intensive care unit"},{"word":"Critical care"},{"word":"Emergency department-based intensive care unit"},{"word":"emergency department crowding"}],"section":"Emergency Department Operations","is_remote":true,"remote_url":"https://escholarship.org/uc/item/1t3887sw","frozenauthors":[{"first_name":"Jutamas","middle_name":"","last_name":"Saoraya","name_suffix":"","institution":"Chulalongkorn University, Faculty of Medicine, Division of Academic Affairs, Bangkok, Thailand; Chulalongkorn University, Faculty of Medicine, Department of Emergency Medicine, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Canada","department":""},{"first_name":"Liran","middle_name":"","last_name":"Shechtman","name_suffix":"","institution":"University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Canada; Sunnybrook Health Sciences Centre, Department of Critical Care Medicine, Toronto, Canada","department":""},{"first_name":"Paweenuch","middle_name":"","last_name":"Bootjeamjai","name_suffix":"","institution":"Chulalongkorn University, Department of Anesthesiology, Bangkok, Thailand","department":""},{"first_name":"Khrongwong","middle_name":"","last_name":"Musikatavorn","name_suffix":"","institution":"Chulalongkorn University, Faculty of Medicine, Department of Emergency Medicine, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Chulalongkorn University, Faculty of Medicine, Department of Medicine, Bangkok, Thailand","department":""},{"first_name":"Federico","middle_name":"","last_name":"Angriman","name_suffix":"","institution":"University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Canada; Sunnybrook Health Sciences Centre, Department of Critical Care Medicine, Toronto, Canada","department":""}],"date_submitted":"2024-06-17T18:14:14.182000Z","date_accepted":"2024-10-04T19:51:43.994000Z","date_published":"2024-11-27T14:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/24874/galley/30136/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/24874/galley/29909/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/24874/galley/30136/download/"}]}