ER docs sending more patients to the ICU

Emergency physicians are sending more patients to intensive care units than ever before, according to a study released by George Washington University School of Public Health and Health Services (SPHHS) and published in the journal Academic Emergency Medicine.

The study examined admissions to the ICU at hospitals across the nation and found that nearly 50 percent came from emergency departments.

"The increase might be the result of an older, sicker population that needs more care," SPHHS researcher and lead author Peter Mullins said yesterday in a statement. The one question the study couldn't answer, the authors noted, was whether there will be enough ICU capacity in the future to handle the growing number of patients, particularly the elderly.

The study team based its research on data from the National Hospital Ambulatory Care Survey, a sample of U.S. hospital-based emergency departments during a seven-year period. They found ICU admissions jumped from 2.79 million in 2002-2003 to 4.14 million in 2008-2009. Furthermore, researchers found that during the same time frame overall ED admissions grew by only 5.8 percent. 

The study also found that the most common reasons for ICU admissions were unspecified chest pain, congestive heart failure and pneumonia. The largest increase in tests and services provided to ER patients on their way to the ICU involved computed tomography and magnetic resonance imaging. Utilization rates for those tests jumped from 16.8 percent to 37.4 percent. 

Co-author Jesse Pines, M.D., a practicing emergency physician and an associate professor of emergency medicine and health policy at SPHHS, noted that additional research is needed to keep critically ill patients from facing long waits in crowded ERs.

"Studies have shown that the longer ICU patients stay in the emergency department, the more likely they are to die in the hospital," Pines, a FierceHealthcare Editorial Advisory Board member, said in the statement. "Better coordination between the emergency department and ICU staff might help speed transfers and prevent complications caused by long emergency department waits."

To learn more:
- read the study abstract
- here's the SPHHS statement

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