Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 6/2004

01-12-2004 | Review

Clinical review: Impact of emergency department care on intensive care unit costs

Author: David T Huang

Published in: Critical Care | Issue 6/2004

Login to get access

Abstract

Critical care is both expensive and increasing. Emergency department (ED) management of critically ill patients before intensive care unit (ICU) admission is an under-explored area of potential cost saving in the ICU. Although limited, current data suggest that ED care has a significant impact on ICU costs both positive and negative. ICU practices can also affect the ED, with a lack of ICU beds being the primary reason for ED overcrowding and ambulance diversion in the USA. Earlier application in the ED of intensive therapies such as goal-directed therapy and noninvasive ventilation may reduce ICU costs by decreasing length of stay and need for admission. Future critical care policies and health services research should include both the ED and ICU in their analyses.
Literature
1.
Halpern NA, Bettes L, Greenstein R: Federal and nationwide intensive care units and healthcare costs: 1986–1992. Crit Care Med 1994, 22: 2001-2007.PubMed
2.
Angus DC, Kelley MA, Schmitz RJ, White A, Popovich JJ: Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: Can we meet the requirements of an aging population? JAMA 2000, 284: 2762-2770. 10.1001/jama.284.21.2762CrossRefPubMed
3.
Sachdeva RC: Intensive care: a cost effective option for developing countries? Indian J Pediatr 2001, 68: 339-342. (Erratum appears in Indian J Pediatr 2001, 68: 404.)CrossRefPubMed
4.
Apolone G, Melotti RM, Repetto F, Iapichino G: Cost containment: Europe. Italy. New Horiz 1994, 2: 350-356.PubMed
5.
McCaig L, Burt C: National Hospital Ambulatory Medical Care Survey: 2001 Emergency Department Summary. Advance Data from Vital and Health Statistics, Centre for Disease Control and Prevention, National Centre for Health Statistics, 2003 Report No 335
6.
Lambe S, Washington DL, Fink A, Herbst K, Liu HH, Fosse JS, Asch SM: Trends in the use and capacity of California's emergency departments, 1990–1999. Ann Emerg Med 2002, 39: 389-396. 10.1067/mem.2002.122433CrossRefPubMed
7.
Fromm RE Jr, Gibbs LR, McCallum WG, Niziol C, Babcock JC, Gueler AC, Levine RL: Critical care in the emergency department: a time-based study. Crit Care Med 1993, 21: 970-976.CrossRefPubMed
8.
Nguyen HB, Rivers EP, Havstad S, Knoblich B, Ressler JA, Muzzin AM, Tomlanovich MC: Critical care in the emergency department: A physiologic assessment and outcome evaluation. Acad Emerg Med 2000, 7: 1354-1361.CrossRefPubMed
9.
Nelson M, Waldrop RD, Jones J, Randall Z: Critical care provided in an urban emergency department. Am J Emerg Med 1998, 16: 56-59.CrossRefPubMed
10.
Varon J, Fromm RE, Levine RL: Emergency department procedures and length of stay for critically ill medical patients. Ann Emerg Med 1994, 23: 546-549.CrossRefPubMed
11.
Svenson J, Besinger B, Stapczynski JS: Critical care of medical and surgical patients in the ED: Length of stay and initiation of intensive care procedures. Am J Emerg Med 1997, 15: 654-657.CrossRefPubMed
12.
McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, Nielsen M, Barrett D, Smith G, Collins CH: Confidential inquiry into quality of care before admission to intensive care. BMJ 1998, 316: 1853-1858.PubMedCentralCrossRefPubMed
13.
Gray A, Gill S, Airey M, Williams R: Descriptive epidemiology of adult critical care transfers from the emergency department. Emerg Med J 2003, 20: 242-246. 10.1136/emj.20.3.242PubMedCentralCrossRefPubMed
14.
Intensive Care Society: Guidelines for the Transport of the Critically Ill Adult London: Intensive Care Society 2002.
15.
Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, Orr RA: Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics 2003, 112: 793-799.CrossRefPubMed
16.
Carcillo JA, Fields AI, Task Force Committee Members: Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002, 30: 1365-1378. 10.1097/00003246-200206000-00040CrossRefPubMed
17.
Teres D, Rapoport J, Lemeshow S, Kim S, Akhras K: Effects of severity of illness on resource use by survivors and nonsurvivors of severe sepsis at intensive care unit admission. Crit Care Med 2002, 30: 2413-2419. 10.1097/00003246-200211000-00002CrossRefPubMed
18.
Higgins TL, Mcgee WT, Steingrub JS, Rapoport J, Lemeshow S, Teres D: Early indicators of prolonged intensive care unit stay: Impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med 2003, 31: 45-51. 10.1097/00003246-200301000-00007CrossRefPubMed
19.
Grenvik A, Ayres SM, Holbrook PR, Shoemaker WC: Textbook of Critical Care 4 Edition Philadelphia: W.B. Saunders Company 2000.
20.
Bur A: The emergency department in a 2000-bed teaching hospital: saving open ward and intensive care facilities. Eur J Emerg Med 1997, 4: 19-23.PubMed
21.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, for the Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307CrossRefPubMed
22.
Evans TW, Albert RK, Angus DC, Bion JF, Chiche J-D, Epstein SK, Fagon JY, Ranieri M, Sznajder JI, Torres A, et al.: International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 2001, 163: 283-291.CrossRef
23.
Crane SD, Elliott MW, Gilligan P, Richards K, Gray AJ: Randomised controlled comparison of continuous positive airways pressure, bilevel non-invasive ventilation, and standard treatment in emergency department patients with acute cardiogenic pulmonary oedema. Emerg Med J 2004, 21: 155-161. 10.1136/emj.2003.005413PubMedCentralCrossRefPubMed
24.
Giacomini : Short-term noninvasive pressure support ventilation prevents ICU admittance in patients with acute cardiogenic pulmonary edema (vol 123, pg 2003). Chest 2003, 124: 1181.
25.
Rahim MT, Milbrandt EB, Dremsizov TT, Kersten A, Linde-Zwirble WT, Watson RS, Clermont G, Angus DC: Pricing critical care: an updated Russell equation [abstract]. Crit Care Med 2004, Suppl 1: P76.
26.
Taheri PA, Butz DA, Greenfield LJ: Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg 2000, 191: 123-130. 10.1016/S1072-7515(00)00352-5CrossRefPubMed
27.
Liesching T, Kwok H, Hill NS: Acute applications of noninvasive positive pressure ventilation. Chest 2003, 124: 699-713. 10.1378/chest.124.2.699CrossRefPubMed
28.
Rivers EP, Nguyen HB, Huang DT, Donnino MW: Critical care and emergency medicine. Curr Opin Crit Care 2002, 8: 600-606. 10.1097/00075198-200212000-00020CrossRefPubMed
29.
Huang DT, Angus DC, Dremsizov TT, Rivers EP, Clermont G: Cost-effectiveness analysis of early goal-directed therapy in the treatment of severe sepsis and septic shock [abstract]. Crit Care 2003, Suppl 2: S116.
30.
31.
United States General Accounting Office: Hospital Emergency Departments: Crowded Conditions Vary Among Hospitals and Communities. Report to the Ranking Minority Member, Commitee on Finance, US Senate 2003. GAO-03-460
32.
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH: Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002, 288: 1987-1993. 10.1001/jama.288.16.1987CrossRefPubMed
33.
34.
Forster AJ, Stiell I, Wells G, Lee AJ, van Walraven C: The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 2003, 10: 127-133. 10.1197/aemj.10.2.127CrossRefPubMed
35.
Clark K, Normile LB: Delays in implementing admission orders for critical care patients associated with length of stay in emergency departments in six mid-atlantic states. J Emerg Nursing 2002, 28: 489-495. 10.1067/men.2002.128714CrossRef
36.
Warren J, Fromm RE Jr, Orr RA, Rotello LC, Horst HM: Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 2004, 32: 256-262. 10.1097/01.CCM.0000104917.39204.0ACrossRefPubMed
37.
38.
Bright D, Walker W, Bion J: Clinical review: outreach – a strategy for improving the care of the acutely ill hospitalized patient. Crit Care 2004, 8: 33-40. 10.1186/cc2377PubMedCentralCrossRefPubMed
39.
Ball C, Kirkby M, Williams S: Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 2003, 327: 1014-1016A. 10.1136/bmj.327.7422.1014PubMedCentralCrossRefPubMed
40.
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV: Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 2002, 324: 387-390. 10.1136/bmj.324.7334.387PubMedCentralCrossRefPubMed
41.
Nightingale P: Improving the care of the seriously ill patient: the interface between the accident and emergency department and critical care areas. Emerg Med J 2001, 18: 326-327. 10.1136/emj.18.5.326PubMedCentralCrossRefPubMed
42.
43.
Melanson P: Critical care medicine as a subspecialty of emergency medicine. CJEM 2000, 2: 258-261.PubMed
44.
Gunn S, Grenvik A: Emergency medicine and critical care certification. Acad Emerg Med 2002, 9: 322-323. 10.1197/aemj.9.4.322CrossRefPubMed
45.
Hore CT, Lancashire W, Roberts JB, Fassett R: Integrated critical care: an approach to specialist cover for critical care in the rural setting. Med J Aust 2003, 179: 95-97.PubMed
46.
Metadata
Title
Clinical review: Impact of emergency department care on intensive care unit costs
Author
David T Huang
Publication date
01-12-2004
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2004
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc2920

Other articles of this Issue 6/2004

Critical Care 6/2004 Go to the issue

Research

Extravascular lung water assessed by transpulmonary single thermodilution and postmortem gravimetry in sheep

Editorial

Evidence-based medicine journal club

Commentary

Tight blood glucose control: a recommendation applicable to any critically ill patient?

Review

Clinical review: Immunomodulatory effects of dopamine in general inflammation

Review

Statistics review 13: Receiver operating characteristic curves

Research

Population-based epidemiology of intensive care: critical importance of ascertainment of residency status