Characteristics of Short-stay Critical Care Admissions From Emergency Departments in Maryland.

Abstract

Critical care is an expensive and limited resource, and short-stay critical care admissions may be treated in alternate, less costly settings. This study objective was to determine the proportion of critical care admissions with a short critical care length of stay (LOS) and identify the clinical characteristics and diagnoses associated with high and low rates of short-stay critical care admissions. This study was a secondary analysis of the 2011 Maryland State Inpatient Database. The study included adult emergency department (ED) visits admitted to a critical care unit. We compared clinical data and discharge diagnoses for short- (≤1 day) versus longer- (≥2 days) stay critical care admissions. A total of 30,212 critical care admissions were eligible, of which 11,494 (38.0%) were short stay. There were significant differences in age, insurance, and comorbidities between the short-stay and the longer-stay critical care admissions. Of short-stay critical care admissions, 3,404 (29.6%) also had a 1-day overall hospital LOS. The diagnoses with the highest proportion of short-stay critical care admissions were nonspecific chest pain (87.9%), syncope (70.6%), and transient cerebral ischemia (67.6%) and the lowest proportion were respiratory failure (17.9%), sepsis (19.4%), and aspiration pneumonitis (19.8%). Over one-third of critical care admissions were short stay. Alternate strategies to manage these patients, including ED-based critical care units or other venues of inpatient care, may be more cost-efficient for selected patients.