104: Impact of Time in the Emergency Department on Mortality in Patients Admitted to the Icu

Introduction: Increased patient volume and limited ICU capacity and resources has resulted in prolonged emergency department (ED) length of stay (LOS). We aimed to study the impact of time in ED on hospital mortality in a large community hospital. Methods: Data included Acute Physiology and Chronic Health Evaluation (APACHE IV) score, acute physiologic score (APS), Time in ED (TED, the duration from ED admission to ICU admission), hospital LOS, and hospital mortality. Data was obtained from EHR (EPIC) and APACHE outcome database. This community hospital is a level 1 trauma center, comprehensive stroke center, with1200 hospital beds, 75 ICU beds (medical, surgical, neuro-trauma, and cardiovascular), and 75 ED beds (100,000 ED visits annually). Results: A total of 3538 patients were included (average TED of 5.5±4.5 hours), divided into three groups: Group 1 (TED < 3.5 hours, n = 1218), Group 2 (TED 3.5 – 6 hours, n = 1276), and Group 3 (TED 6 – 24 hours, n = 1044). All three groups had similar APACHE scores (46±21, 46±23, 46±20; p = 1.0), APS scores (35±18, 35±21, 34±18; p = 1.0) and hospital LOS in days (7.8±7.7, 7.6±7.2, 7.5±7,2; p = 0.5, 0.3). Compared to Group 1 (TED 2.5±0.1, mortality 6.7 %), Group 2 and Group 3 had longer TED (4.5±0.1, p = 0.001 and 9.4±0.2; p = 0.001 respectively) and higher hospital mortality (11 %; p = 0.002 and 13 %; p = 0.001 respectively). Conclusions: Prolonged emergency department length of stay prior to ICU admission is associated with significantly increased hospital mortality, even when patient severity of illness is similar. These findings suggest that earlier transfer to the ICU may improve outcomes and highlight the importance of addressing ED boarding times in critically ill patients.