Associated Outcomes and Hospital Costs of Emergency Department Sepsis Patients with Delayed Intensive Care Unit Disposition
CCCF ePoster library. Fernando S. Nov 7, 2018; 233338; 38
Dr. Shannon Fernando
Dr. Shannon Fernando
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Abstract
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Background: Following Emergency Department (ED) assessment, patients with infection may be directly admitted to the Intensive Care Unit (ICU), or alternatively admitted to hospital wards or sent home. Those admitted to the hospital wards or sent home may experience future deterioration necessitating ICU admission. Little is known regarding outcomes and costs of these ED sepsis patients with delayed ICU disposition. We categorized patients into three groups: 1) admitted directly to ICU; 2) initially admitted to the hospital wards, with ICU admission within 72 hours; or 3) Sent home from ED, with ICU admission within 72 hours. We sought to compare outcomes and total costs between groups.

 

Objectives: We categorized patients into three groups: 1) admitted directly to ICU; 2) initially admitted to the hospital wards, with ICU admission within 72 hours; or 3) Sent home from ED, with ICU admission within 72 hours. We sought to compare outcomes and total costs between groups.

 

Methods: This retrospective cohort study was performed in two tertiary care hospital ICUs, within The Ottawa Hospital network. Patients were enrolled between January 1, 2011 and December 31, 2014. Patients with a primary diagnosis of infection or sepsis were identified and included in the analysis. Identification was performed using International Classification of Diseases, 10th Revision (ICD-10) codes. Patient characteristics, outcomes, and costs were gathered from The Ottawa Hospital Data Warehouse.

 

Results: 657 total patients with infection or sepsis and ICU admission within 72 hours of ED arrival were included. 338 (51.4%) were admitted directly from ED to ICU, 246 (37.4%) were initially admitted to the wards and then to ICU, and 73 (11.1%) were initially sent home and then admitted to ICU. In-hospital mortality was lowest among patients admitted directly to the ICU (29.5%), as compared to patients admitted to ICU from wards (42.7%), or home (61.6%) (P<0.001). Mean total costs were lowest among patients directly admitted to the ICU ($26,748), as compared to those admitted from the wards ($107,315), and those initially sent home ($71,492) (P<0.001). Cost per survivor was lower among patients directly admitted to the ICU ($37,986) than either those initially admitted to the wards ($187,230), or those sent home ($186,390) (P<0.001).  

 

Conclusions: In comparison with direct admission to the ICU, patients with sepsis admitted to the ICU who have been previously discharged home or admitted to the ward are associated with higher in-hospital mortality and costs.


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