Management and outcomes of critically ill patients admitted to a critical care resuscitation unit: a retrospective cohort study

Background Providing early support to critically ill patients before intensive care unit (ICU) admission improves morbidity and mortality. We aimed to evaluate the management and outcomes of critically ill patients admitted to a critical care resuscitation unit (CCRU). Methods This retrospective study was conducted in the CCRU of a tertiary hospital and included adults (≥18 years) admitted from November 2015 until March 2020 and from July 2021 until December 2023. The primary outcome was the disposition category at CCRU discharge. Comparisons with a historical control group of critically ill emergency department (ED) patients prior to CCRU implementation were made. Results 2059 CCRU patients (median age 70 years; 57.4% male) were analysed. Patients were admitted to the CCRU from the ED (72.2%), wards (18%), emergency medical services (6.7%) or other sources (3.2%). Following a median CCRU length of stay of 2.7 (IQR 1.7–4.2) hours, during which 2 (IQR 1–4) critical care interventions per patient were delivered, 911 patients (44.2%) required ICU admission, while 978 (47.5%) and 74 (3.6%) patients were admitted to general wards or discharged home. 84 patients (4.1%) died in the CCRU. Compared with a historical control group, the ICU admission rate of ED patients (0.73 vs 0.56%, p<0.001) and the delay between ED presentation and ICU or CCRU admission decreased after CCRU implementation (1.87 (0.48–6.53) vs 0.85 (0.48–2.79) hours, p<0.001). Conclusion The CCRU at a large tertiary centre admitted critically ill patients with a wide range of emergencies. Following a short treatment period, during which several critical care interventions were delivered, less than half of CCRU patients required subsequent ICU admission. Comparisons with a historical control group suggest that CCRU implementation reduced the ICU admission rate and time to initiation of critical care for ED patients.