When someone has been in a serious accident or is having a stroke, the faster they get to specialists who can treat them, the better their outcomes.
A new study from Critical Care Medicine (June 2007) says that critically ill emergency department patients with a six hour or longer delay in getting from the Emergency Room (ER) to an Intensive Care Unit (ICU) had :
1. Increased hospital length of stay and
2. Higher intensive care unit mortality. (The patient died in the ICU.)
3. Higher hospital mortality. (The patient died after transfer from an ICU to another unit in the hospital.
Although the delays in transfer were identified as one cause of death, the authors say that other causes need to be studied.
Emergency Rooms are staffed or equipped to stabilize and monitor a patient who needs to be in an Intensive Care Unit (ICU) while waiting for an available bed in a unit staffed and equipped to meet your patient’s needs.
Many hospitals have to “board” patients in the Emergency Department because an Intensive Care Unit (ICU) bed is not available.
Why?
Some causes contributing to delays in patient transfers to ICUS include:
- The ICU appropriate for you or your patient is full.
- There are beds available but they are not “open.” There are no nurses available.
- A specific hospital’s transfer process (from ER to ICU) is not fast enough.*
Citation: Crit Care Med. 2007 Jun;35(6):1614-5
PMID: 17440421 [PubMed - indexed for MEDLINE]
* These possible causes for delayed tranfers were not identified in the study.
TPR Tip: What can you do if you have a patient being boarded in the Emergency Room?
- Call the patient’s regular doctor and ask for help in getting the patient assessed and transferred.
- Ask the doctor to ask the ER staff how long it will be before the patient is in an ICU?
- Ask your doctor to find out if everything that can be done there is being done.
- If the answers to these questions tell you your patient is going to be waiting six hours or more, ask your doctor if the patient can be safely transferred to a nearby hospital or
regional medical center. Based on these study’s findings, that is a smart question to ask.
- If it is winter, and every ICU in your area is full, there may be nothing you can do.
- If the patient is said to be so unstable that a transfer to another hospital would be too risky, ask why.
- You will want to understand the why because it tells you what is going on with your
friend or family member.
- You and the patient’s regular doctor may want to get another opinion about the safety of a transfer.
- Transfers require a doctor to authorize one and another doctor on the other end to formally accept the patient. That takes some hustling to get organized.
Bear in mind that Emergency Rooms in this nation are struggling with high volumes now. They, too, have a crisis. The ER staff can not make an ICU bed open up. They can, however, do everything an emergency room staff can do until the bed opens up.
Get medical help to be sure that all that can be done is being done. If you can’t find the doctor, ask these questions yourself.
Although you may be upset, Emergency Room staffs appreciate it when family members are courteous and do their best to keep their emotions under control while there. Make it easier for them to do their jobs by talking with the patient in a calm, low voice.
That can be hard to do but it works.