Critical care in the emergency department: A time-based study

R. E. Fromm, L. R. Gibbs, W. G.B. McCallum, C. Niziol, J. C. Babcock, A. C. Gueler, R. L. Levine

Research output: Contribution to journalArticlepeer-review

91 Scopus citations


Objectives: Emergency departments serve many functions in the current U.S. healthcare system, including initial management of patients with critical illnesses and primary care for a growing proportion of the population. Overcrowding of emergency departments is a growing problem. Delays in admitting patients to inpatient units have been reported as a contributing factor to overcrowding. To date, the effect of the critically ill patients on the emergency department has not been fully described. It was the purpose of this study to examine the incidence of critical illness in the emergency department and its total burden as reflected in emergency department length of stay. Design: Prospective, cohort study in 17,900 emergency department patients. Setting: Single, not-for-profit teaching hospital. Patients: All patients admitted to the emergency department during the period of April 1, 1991 to March 31, 1992. Interventions: None. Measurements and Main Results: Date and time of arrival in the emergency department and time of discharge, death, or admission to an inpatient unit were recorded. Patients admitted to intensive care units/special care units from the emergency department were defined as critically ill. All other patients were classified as noncritically ill. Emergency department length of stay was calculated as the time from arrival in the emergency department until discharge, death, or admission to an inpatient unit. Differences in length of stay were determined using Kruskal-Wallis analysis by ranks. The study population totaled 17,900 patients: 8.5% (n = 1,527) critically ill patients, 61.1% (n = 10,930) discharged patients, and 30.4% (n = 5,443) noncritically ill admitted patients. Mean emergency department length of stay for the critically ill patients was 145.3 ± 89.6 mins (maximum length of stay, 655 mins), and for the noncritically ill patients, mean stay was 153.1 ± 91.9 mins (maximum length of stay, 781 mins) (p < .0003). During the study period, 154 patient- days of emergency department critical care were provided. Conclusions: Critically ill patients constitute an important proportion of emergency department practice and may remain in the emergency department for significant periods of time. Solutions to emergency department overcrowding may include alternatives for continuing management of critically ill patients. Given the realities of emergency department practice, emergency medicine practitioners should receive training in the continuing management of critically ill patients.

Original languageEnglish (US)
Pages (from-to)970-976
Number of pages7
JournalCritical care medicine
Issue number7
StatePublished - Jan 1 1993


  • access to care
  • circadian variation
  • critical care
  • emergency medicine
  • ethics
  • healthcare administration
  • healthcare utilization
  • intensive care units
  • length of stay
  • quality assurance

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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