Abstract
Background
Many emergency department (ED) patients in diabetic ketoacidosis (DKA) are admitted
to an inpatient intensive care unit (ICU), while ICU capacity is under increasing
strain. The Emergency Critical Care Center (EC3), a hybrid ED-ICU setting, opened
with the goal of providing rapid initiation of ICU care in the ED.
Objective
We sought to evaluate the impact of an ED-ICU on disposition and safety outcomes for
adult ED patients in DKA.
Methods
This was a retrospective pre–post cohort of ED visits from 2012–2018 at a single academic
medical center. Adult ED patients in DKA (pH < 7.30, HCO3 < 18 mEq/L, anion gap > 14, and glucose > 250 mg/dL) immediately before (pre-EC3)
and after (post-EC3) opening of an ED-ICU were identified. ED disposition and safety
data were collected and analyzed.
Results
We identified 631 patient encounters: 217 pre-EC3 and 414 post-EC3. Baseline demographics
were similar between cohorts. Fewer patients in the post-EC3 cohort were admitted
to an ICU (11.6% vs. 23.5%, p < 0.001, number needed to treat [NNT] = 8) or general floor bed (58.0% vs. 73.3%,
p < 0.001, NNT = 6), and more were discharged from the ED (27.1% vs. 1.4%, p < 0.001, NNT = 4). Rates of hypokalemia (10.1% vs. 6.0%, p = 0.08) and admission to non-ICU with transfer to ICU within 24 h (0.5% vs. 0%, p = 0.30) did not differ.
Conclusion
Management of patients with DKA in an ED-ICU was associated with decreased ICU and
hospital utilization with similar safety outcomes. Managing rapidly reversible critical
illnesses in an ED-ICU may help obviate increasing strain facing many health care
systems.
Keywords
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Article info
Publication history
Published online: December 13, 2019
Accepted:
October 13,
2019
Received in revised form:
September 27,
2019
Received:
June 17,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
