BACKGROUND: Critical care delivery in the emergency department (ED) may improve selected patient- and system-relevant outcomes. However, it remains unclear which organisational models to deliver critical care in the ED (CC-ED) have been implemented and what their outcome effects are. METHODS: We conducted a systematic review and meta-analysis including studies describing organisational approaches to deliver CC-ED. Delivery models were categorised and described qualitatively. For studies reporting comparable outcomes, random-effects meta-analysis was performed to estimate pooled effects and 95% confidence intervals. Outcomes included mortality, intensive care unit (ICU) admission rates, ICU length of stay (LOS), hospital LOS, and cost of care. RESULTS: Of 4,967 records, 67 were included into the qualitative assessment and 11 studies into the quantitative analysis, respectively. We identified five models to deliver CC-ED. These consisted of dedicated critical care areas in the ED (n = 49/67, 73.1%), placement of critical care staff in the ED (n = 5/67, 7.5%), deployment of critical care teams to the ED (n = 5/67, 7.5%), telemedical support of ED staff by critical care teams (n = 5/67, 7.5%), and implementation of protocols to accelerate ICU admission (n = 3/67, 4.5%). Mortality was not different versus usual care in any of the CC-ED models. CC-ED models had variable effects on the ICU admission rate, hospital and ICU LOS. Dedicated critical care areas in the ED were associated with lower ICU admission rates OR 0.83 (0.76-0.91), p < 0.001, and shorter hospital LOS mean difference - 0.31 (-0.59 to -0.03) days, p = 0.03, but longer ICU LOS mean difference 0.45 (0.31-0.6) days, p < 0.001. Reported cost of care did not differ between CC-ED and usual care. CONCLUSIONS: We identified five different organisational model categories to deliver CC-ED. Dedicated critical care areas such as ED-ICUs was the model category most frequently published. Our quantitative meta-analysis suggests that compared with other CC-ED delivery models, dedicated critical care areas in the ED may reduce both ICU admission rates and hospital LOS of critically ill ED patients.
Noitz et al. (Sun,) studied this question.