Title: The management of the poisoned patient using a novel emergency department-based resuscitation and critical care unit (ResCCU).
Authors: Mudan, Anita; Love, Jennifer S; Greenwood, John C; Stickley, Carolyn; Zhou, Victoria L; Shofer, Frances S; Jang, David H
Published In Am J Emerg Med, (2020 10)
Abstract: OBJECTIVES: The Resuscitation & Critical Care Unit (ResCCU) is a novel ED-based ICU designed to provide early critical care services. This study sought to identify characteristics of poisoned patients treated in the ResCCU. METHODS: We conducted a retrospective, single-center case study of poisoned patients over the age of 18 years old over a 16-month period. Patient demographics, drug concentrations, and severity of illness scores were extracted from electronic medical records. Patients were divided into two groups, those who required short term ICU level care (< 24 h) and prolonged ICU care (> 24 h). RESULTS: A total of 58 ED visits with a tox-related illness were analyzed. There were 24 women (41%) and 34 men (59%). There were 42 patients (72%) who required short term ICU level care and 16 patients (28%) who required prolonged ICU care. In the short-term ICU group, 13 patients (31%) were discharged home directly from the ResCCU, 29 patients (69%) were sent to the inpatient floor, and 1 of the admitted floor patients expired. There were no patients admitted to the floor that required a step-up to the inpatient ICU. 56 patients (97%) were alive at post-admit day 7 and 28, and only 8 (14%) were re-admitted within 30 days. CONCLUSIONS: Patients who were treated in the ED-based ICU for toxicology-related illnesses were frequently able to be either discharged home or admitted to a regular floor after their initial stabilization and treatment, and none that were sent to the floor required an ICU step-up.
PubMed ID: 33142177
MeSH Terms: APACHE; Adolescent; Adult; Aged; Cohort Studies; Critical Care/methods; Critical Care/trends; Disease Management; Emergency Service, Hospital/organization & administration; Emergency Service, Hospital/trends; Female; Hospitalization; Humans; Length of Stay/statistics & numerical data; Male; Middle Aged; Organ Dysfunction Scores; Poisoning/complications; Poisoning/therapy*; Prospective Studies; Quality Improvement; Resuscitation/methods; Resuscitation/standards; Resuscitation/trends*; Retrospective Studies