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Increasing Critical Care Admissions From U.S. Emergency Departments, 2001–2009*

Herring, Andrew A. MD1; Ginde, Adit A. MD, MPH2; Fahimi, Jahan MD, MPH1; Alter, Harrison J. MD, MS1; Maselli, Judith H. MSPH3; Espinola, Janice A. MPH4; Sullivan, Ashley F. MS, MPH4; Camargo, Carlos A. Jr. MD, DrPH4

doi: 10.1097/CCM.0b013e31827c086f
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Objectives: Little is known about how recent system-wide increases in demand for critical care have affected U.S. emergency departments (EDs). This study describes changes in the amount of critical care provided in U.S. EDs between 2001 and 2009.

Design: Analysis of data from the National Hospital Ambulatory Medical Care Survey for the years 2001–2009.

Setting: National multistage probability sample of U.S. ED data. U.S. ED capacity was estimated using the National Emergency Department Inventory-United States.

Patients: ED patients admitted a critical care unit.

Interventions: None.

Measurements: Annual hours of ED-based critical care and annual number critical care ED visits. Clinical characteristics, demographics, insurance status, setting, geographic region, and ED length of stay for critically ill ED patients.

Main Results: Annual critical care unit admissions from U.S. EDs increased by 79% from 1.2 to 2.2 million. The proportion of all ED visits resulting in critical care unit admission increased from 0.9% to 1.6% (p trend < 0.001). Between 2001 and 2009, the median ED length of stay for critically ill patients increased from 185 to 245 minutes (+ 60 min; p trend < 0.02). For the aggregated years 2001–2009, ED length of stay for critical care visits was longer among black patients (12.6% longer) and Hispanic patients (14.8% longer) than among white patients, and one third of all critical care ED visits had an ED length of stay greater than 6 hrs. Between 2001 and 2009, total annual hours of critical care at U.S. EDs increased by 217% from 3.2 to 10.1 million (p trend < 0.001). The average daily amount of critical care provided in U.S. EDs tripled from 1.8 to 5.6 hours per ED per day.

Conclusions: The amount of critical care provided in U.S. EDs has increased substantially over the past decade, driven by increasing numbers of critical care ED visits and lengthening ED length of stay. Increased critical care burden will further stress an already overcapacity U.S. emergency care system.

1Department of Emergency Medicine, Alameda County Medical Center, Highland Hospital, Oakland, CA.

2Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.

3Department of Medicine, University of California, San Francisco, CA.

4Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

*See also p. 1367.

Presented at the Society for Academic Emergency Medicine annual meeting, June 2011, Boston, MA.

Dr. Maselli received funding from the CDC. The remaining authors have not disclosed any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins