Association of Prolonged Emergency Department Length of Stay With Process of Care Measures for Critically Ill...

To explore the association between a prolonged emergency department (ED) length of stay and the deployment of process of care measures (e.g., low tidal volume ventilation) for critically ill patients.

Retrospective cohort study.

Eight academic ICUs in Toronto.

Mechanically ventilated adult patients who were directly admitted to the ICU from the ED from June 2014 to February 2023.

None.

The cohort was divided into a short ED stay group (i.e., < 6 hr) and a prolonged ED stay group (i.e., from 6 to 24 hr). We used propensity score methods and multivariable logistic regression models to estimate the association between a prolonged ED stay and the receipt of process of care measures on day 2 after ICU admission, adjusting for baseline characteristics. Associations were reported as odds ratios (ORs) and 95% CIs. We included 7072 patients, of whom 1462 (21%) had a prolonged ED stay. Both groups had comparable severity of illness at baseline. There was no difference in the deployment of processes of care measures on day 2 after ICU admission between the two groups. The adjusted OR for the prolonged ED stay group compared with a short ED stay group for each measure were as follows: low tidal volume ventilation 0.92 (95% CI, 0.68-1.22), spontaneous breathing trial 1.12 (95% CI, 0.92-1.35), extubation among those eligible 0.78 (95% CI, 0.55-1.12), deep vein thrombosis prophylaxis 1.13 (95% CI, 0.95-1.34), and continuous sedation 0.92 (95% CI, 0.81-1.06).

In this multicenter study of critically ill adult patients, a prolonged ED stay was not associated with a significant difference in the deployment of evidence-based process of care measures for critically ill adult patients.