ArticleCritical care (London, England)2018
Emergency Department disposition decisions and associated mortality and costs in ICU patients with suspected infection.
Article in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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Who cites it
26 citing papers in PubMed.
- A work systems approach to characterizing emergency department disposition decision-making under low and high demand.Applied ergonomics · 2026Article
- Predicting Future Organ Support Needs Using Longitudinal Emergency Department Data: A Proof-of-Concept Study.Research square · 2026Article
- Article
- A Heart Rate Variability-Derived Decision Support Tool for Prognostication in Emergency Department Patients With Suspected Infection.BioMed research international · 2026Observational
- The value of plasma presepsin as a diagnostic and prognostic biomarker for febrile neutropenia in children.Annals of medicine · 2025Article
- A machine learning and centrifugal microfluidics platform for bedside prediction of sepsis.Nature communications · 2025Article
- An Investigation into Demographic Disparities in Emergency Department Disposition Decisions.Production and operations management · 2025Article
- The Evolving Role of Ultrasound in Diagnosis and Treatment of Eye Emergencies: A Narrative Review.Clinical ophthalmology (Auckland, N.Z.) · 2025Review
- Roadmap for the evolution of monitoring: developing and evaluating waveform-based variability-derived artificial intelligence-powered predictive clinical decision support software tools.Critical care (London, England) · 2024Review
- Association between emergency department disposition and mortality in patients with COVID-19 acute respiratory distress syndrome.Journal of the American College of Emergency Physicians open · 2024Article
- Multisite development and validation of machine learning models to predict severe outcomes and guide decision-making for emergency department patients with influenza.Journal of the American College of Emergency Physicians open · 2024Article
- Identifying Patient Subpopulations with Significant Race-Sex Differences in Emergency Department Disposition Decisions.Health services insights · 2024Article
- Antibiotic Guideline Adherence at the Emergency Department: A Descriptive Study from a Country with a Restrictive Antibiotic Policy.Antibiotics (Basel, Switzerland) · 2023Article
- Examination of Impact of After-Hours Admissions on Hospital Resource Use, Patient Outcomes, and Costs.Critical care research and practice · 2022Article
- The role of procalcitonin in identifying high-risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score.Cancer medicine · 2021Article
- Failure mode and effects analysis on the control effect of multi-drug-resistant bacteria in ICU patients.American journal of translational research · 2021Article
- Article
- On Baseball, Counterfactuals, and Measuring Care Delivery Performance at the Emergency Department-Intensive Care Unit Interface.Annals of the American Thoracic Society · 2020Article
- Fever in returning travellers and migrants: disease severity markers to improve triage and management.Journal of travel medicine · 2020Article
- Association of a Care Bundle for Early Sepsis Management With Mortality Among Patients With Hospital-Onset or Community-Onset Sepsis.JAMA internal medicine · 2020Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFollowing emergency department (ED) assessment, patients with infection may be directly admitted to the intensive care unit (ICU) or alternatively admitted to hospital wards or sent home. Those admitted to the hospital wards or sent home may experience future deterioration necessitating ICU admission.
methodsWe used a prospectively collected registry from two hospitals within a single tertiary care hospital network between 2011 and 2014. Patient information, outcomes, and costs were stored in the hospital data warehouse. Patients were categorized into three groups: (1) admitted directly from the ED to the ICU; (2) initially admitted to the hospital wards, with ICU admission within 72 hours of initial presentation; or (3) sent home from the ED, with ICU admission within 72 hours of initial presentation. Using multivariable logistic regression, we sought to compare outcomes and total costs between groups. Total costs were evaluated using a generalized linear model.
resultsA total of 657 patients were included; of these, 338 (51.4%) were admitted directly from the ED to the ICU, 246 (37.4%) were initially admitted to the wards and then to the ICU, and 73 (11.1%) were initially sent home and then admitted to the ICU. In-hospital mortality was lowest among patients admitted directly to the ICU (29.5%), as compared with patients admitted to the ICU from wards (42.7%) or home (61.6%) (P < 0.001). As compared with direct ICU admission, disposition to the ward was associated with an adjusted OR of 1.75 (95% CI, 1.22-2.50; P < 0.01) for mortality, and disposition home was associated with an adjusted OR of 4.02 (95% CI, 2.32-6.98). Mean total costs were lowest among patients directly admitted to the ICU ($26,748), as compared with those admitted from the wards ($107,315) and those initially sent home ($71,492) (P < 0.001). Cost per survivor was lower among patients directly admitted to the ICU ($37,986) than either those initially admitted to the wards ($187,230) or those sent home ($186,390) (P < 0.001).
conclusionsIn comparison with direct admission to the ICU, patients with suspected infection admitted to the ICU who have previously been discharged home or admitted to the ward are associated with higher in-hospital mortality and costs.
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