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Emergency responses for clinical deterioration within and beyond 24 hours of emergency admission: Patient outcomes and ICU implications

Currey, J., Charlesworth, D and Considine, J. 2015, Emergency responses for clinical deterioration within and beyond 24 hours of emergency admission: Patient outcomes and ICU implications, in Australian Critical Care, ELSEVIER SCIENCE INC,, pp. 40-40, doi: 10.1016/j.aucc.2014.10.009.

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Title Emergency responses for clinical deterioration within and beyond 24 hours of emergency admission: Patient outcomes and ICU implications
Author(s) Currey, J.ORCID iD for Currey, J. orcid.org/0000-0002-0574-0054
Charlesworth, D
Considine, J.ORCID iD for Considine, J. orcid.org/0000-0003-3801-2456
Conference location a
Conference dates a
Title of proceedings Australian Critical Care
Publication date 2015
Start page 40
End page 40
Total pages 1
Publisher ELSEVIER SCIENCE INC
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Nursing
Summary Introduction: The National Emergency Access Target was implemented to ensure 90% of patients leave emergency departments (EDs) within 4h. The impact of time driven performance on the number of physiologically unstable ward-based patients is unknown. An increase in clinical deterioration episodes potentially leading to adverse events will have resource implications for intensive care units (ICUs).
Objectives: To compare the characteristics and outcomes of patients who required an emergency response for clinical deterioration (cardiac arrest team or rapid response system activation) within and beyond 24 h of emergency admission to general medical and surgical units.
Methods: A retrospective exploratory design was used. The study site was a 365 bed urban hospital in Melbourne. Emergency responses for clinical deterioration during 2012 were examined.
Results: Of 819 emergency responses for clinical deterioration, 587 patients were admitted via ED. The median time to first responsewas59h, 28.4% of patients required this <24 h after admission. One in eight patients required ICU admission. Comparison of patients requiring a response within and beyond 24h of admission showed no significant differences in age, gender, waiting times, ED length of stay or in-hospital mortality rates. Patients in whom first emergency response occurred <24h after admission were less likely to be admitted to ICU immediately following the emergency response (7.6% vs 13.9%, p-0.039), less likely to have recurrent emergency responses during their hospitalisation (9.7% vs 34.0%, p<0.001), and had shorter median hospital length of stay (7 vs 11 days, p<0.001).
Conclusions: Considerable ICU resources were utilised given one in eight patients required ICU admission following emergency response, and patients admitted via the ED constituted 55% of all rapid response system activations. Exploring potential antecedents to clinical deterioration in this cohort may assist in establishing risk management strategies to reduce utilisation of ICU resources.
ISSN 1036-7314
Language eng
DOI 10.1016/j.aucc.2014.10.009
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category E3 Extract of paper
Persistent URL http://hdl.handle.net/10536/DRO/DU:30072665

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