Critical Care Resuscitation Unit: An Innovative Solution to Expedite Transfer of Patients with Time-Sensitive Critical Illness

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• 作者：Thomas M. Scalea ; MD ; FACS ; MCCM^a ; ^{tscalea@umm.edu" class="auth_mail" title="E-mail the corresponding author} ; Lewis Rubinson ; MD ; PhD^b ; Quincy Tran ; MD ; PhD^c ; Kevin M. Jones ; MD^c ; Jeffrey H. Rea ; MD^c ; Deborah M. Stein ; MD ; MPH ; FACS ; FCCM^a ; Stephen T. Bartlett ; MD ; FACS^a ; James V. O'Connor ; MD ; FACS ; FCCP^a
• 关键词：ACES ; acute care emergency service ; CCRU ; critical care resuscitation unit ; CS ; cardiac surgery service ; MEC ; Maryland Express Care ; STC ; shock trauma center ; UMMC ; University of Maryland Medical Center
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：222
• 期：4
• 页码：614-621
• 全文大小：333 K

文摘

Time-sensitive, critical surgical illnesses require care at specialized centers. Trauma systems facilitate patient transport to designated trauma centers, but formal systems for nontraumatic critical illness do not exist. We created the critical care resuscitation unit to expedite transfers of adult critically ill patients with time-sensitive conditions to a quaternary academic medical center, hypothesizing that this would decrease time to transfer, increase transfer volume, and improve outcomes.

Study Design

Critical care transfers to the University of Maryland Medical Center during the first year of the critical care resuscitation unit (July 2013 to June 2014) were compared with a previous year (July 2011 to June 2012). Times from transfer request to arrival and operating room and hospital mortality were compared.

Results

There was a 64.5% increase in transfers with a 93.6% increase in critically ill surgical patients. For patients requiring operation, median time to arrival and operating room (118 vs 223 minutes and 1,113 vs 3,424 minutes, respectively; p < 0.001 for both) and median hospital length of stay (13 vs 17 days; p < 0.001) were reduced significantly. There was a nonsignificant trend toward lower mortality (14.6% vs 16.5%; p = 0.27).

Conclusions

The critical care resuscitation unit dramatically increased the volume of critically ill surgical patients. It decreased transfer times, increased volume, and, for those who required urgent operation, decreased time from initial referral to operating room. This benefit seems to be most marked in patients needing urgent operation. This might be a paradigm shift expediting the transfer of patients with time-sensitive critical illness to an appropriately resourced specialty center.