P-20: A Retrospective Chart Review of Critically Ill Patients in the Emergency Department
Chan, D., Kolev, D., Lien, K., Wang, Y., & Tong, X.C.
Objectives: Critically ill patients presenting to the Emergency department (ED) may require aggressive management. The goal of this study is to describe the types of critical care procedures performed in the emergency department and to identify the skills most commonly performed, and most pertinent to ED presentations.
Methods: This is a retrospective chart review of patients who presented to the ED in GRH or SMGH that were 18 or older AND were registered in the ED AND were either transferred to the ICU or pronounced dead in the ED. Patient demographics, LOS, and invasive procedures done in the ED and first 24 hours of ICU admission were recorded.
Results: Of the 334 charts reviewed at GRH and SMGH, 293 procedures were performed on 158 patients. Of the patients that required a critical care procedure in the first 24h, 86% were performed in the ED; the remaining 14% were performed in the ICU. 88% of the endotracheal intubations, 73% of the central venous lines, 33% of the arterial lines were performed in the ED. All the intraosseous lines, chest tubes, lumbar punctures, and pericardiocentesis combined constituted only 7% of all procedures.
Conclusions: This study identifies the frequency critical care interventions are performed in critically ill patients admitted to the ED. Some of these procedures were infrequent and may lead to an increased risk for skill deterioration. Not only is the importance of critical care procedures in emergency medicine is demonstrated here, but the need to develop solutions to ensure skill maintenance.