ANN ARBOR, Mich. - A new study found having an intensive care unit within the emergency department improved care and survival rates for the entire emergency department population.

"The time patients have to wait in the emergency department for inpatient critical care resources is increasing nationwide, and longer wait times for intensive care units have been associated with decreased survival rates," says Kyle Gunnerson, M.D., an associate professor of emergency critical care medicine at Michigan Medicine.

Gunnerson, the lead author on the study published in JAMA Network Open, examined Michigan Medicine's own emergency department-based intensive care unit, the Massey Family Foundation Emergency Critical Care Center - EC3, and its impact on the rest of the emergency department and the patients it serves.

"By applying cutting-edge critical care diagnostics and therapies to our sickest patients very early in their presentation to the emergency department, we were able to optimize their care in a way that improved outcomes and often reduced the need for an inpatient ICU admission," says Robert Neumar, M.D., Ph.D., professor and chair of emergency medicine at Michigan Medicine and the study's senior author.

Examining data

The EC3 is one of the most advanced emergency critical care centers in the country. The 7,800 square-foot unit opened in February 2015 and has five resuscitation trauma bays and nine patient rooms. The unit is adjacent to the main adult emergency department.

In the study, the research team collected data from electronic health records for all Michigan Medicine emergency department visits between September 1, 2012 and July 31, 2017, and divided them into a pre-EC3 implementation cohort and a post-EC3 implementation cohort. Then they examined 30-day patient mortality outcomes, as well as ICU admission rates, among all emergency department patients before and after EC3 implementation.

"By deploying this new critical care delivery approach in the EC3, we observed an improved survival rate among all of the emergency department patients in our data," says Gunnerson, the medical director of the EC3.

"Mortality rates decreased from 2.13 % pre-EC3 to 1.83% post-EC3 implementation, and the survival benefit was evident for up to 30 days after admission to the emergency department."

The research team also found a decrease in ICU admissions, from 3.2% pre-EC3, to 2.7% post-EC3.

"We were also able to safely decrease ICU admissions because we were able to rapidly initiate that level of care right in our own emergency department," Neumar says. "In addition to improving patient care within the emergency department, this strategy increased the availability of inpatient critical care resources to other patients already in the hospital or awaiting a transfer to our hospital."

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