874: Impact of an emergency critical care unit on the disposition of critically ill toxicology patients.

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Learning Objectives: Intoxication and poisonings place a burden on the critical care system. Drug overdose is now the leading cause of accidental deaths in the United States. Many of these patients require time-sensitive critical care interventions including mechanical ventilation, decontamination, antidote administration and hemodynamic optimization. With the opening of an emergency department based critical care unit (EC3) we hypothesized that earlier intervention could lead to a decrease in ICU admissions, length of stay and a possible a cost-savings.

Methods: This is a retrospective review of electronic medical records (EMR) for toxicology patients evaluated between October 1,2013-February 2015 (pre-EC3) vs February 16, 2015- June 30, 2016 (post-EC3). All adults > 18 years old were included. All agents of intoxication or poisoning were included except for ethanol intoxication.

Results: The mean age of tox patients before and after EC3 opened was comparable 34.1 vs 34.4. The hospital length of stay(LOS) was shorter for patients in the post EC3 intervention cohort vs pre EC3 (1.0 days vs 1.2 days) but not statistically significant p= 0.10. ED LOS was shorter for the post EC-3 patients (5.9 hrs vs 6.9 hrs) and statistically significant p= 0.0002. ICU LOS for post-EC3 patients was actually longer 3.5 days vs 2.0 days for pre-EC3 patients p= 0.007. A total of 112 pts were admitted to ICU (9.0%). The percentage of patients admitted to ICU was statistically significantly higher among pre-EC3 pts (12.4%) compared to the post EC-3 patients (5.8%), p=0.00005. Bivariate LR analysis showed there was a decrease in ICU admission associated with EC3 status, OR= 0.43 (95% CI=0.29, 0.65), p=0.00007. In other words, the odds ratio of going to ICU were about 57% lower among Post-EC3 patients compared to pre-EC3 patients

Conclusions: There was a statistically significant reduction in ICU admissions for critically ill toxicology patients treated in EC3. In addition, EC3 interventions reduced overall ED length of stay but were associated with a longer ICU LOS. Further study of cost savings and comparison of acuity is warranted.


46th Critical Society for Care Congress, Honolulu, HI, January 21-25, 2017.