Association of Prolonged Emergency Department Length of Stay With Process of Care Measures for Critically Ill Patients

OBJECTIVES: To explore the association between a prolonged emergency department (ED) length of stay and the deployment of process of care measures (e.g., low tidal volume ventilation) for critically ill patients. DESIGN: Retrospective cohort study. SETTING: Eight academic ICUs in Toronto. PATIENTS: Mechanically ventilated adult patients who were directly admitted to the ICU from the ED from June 2014 to February 2023. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The cohort was divided into a short ED stay group (i.e., < 6 hr) and a prolonged ED stay group (i.e., from 6 to 24 hr). We used propensity score methods and multivariable logistic regression models to estimate the association between a prolonged ED stay and the receipt of process of care measures on day 2 after ICU admission, adjusting for baseline characteristics. Associations were reported as odds ratios (ORs) and 95% CIs. We included 7072 patients, of whom 1462 (21%) had a prolonged ED stay. Both groups had comparable severity of illness at baseline. There was no difference in the deployment of processes of care measures on day 2 after ICU admission between the two groups. The adjusted OR for the prolonged ED stay group compared with a short ED stay group for each measure were as follows: low tidal volume ventilation 0.92 (95% CI, 0.68-1.22), spontaneous breathing trial 1.12 (95% CI, 0.92-1.35), extubation among those eligible 0.78 (95% CI, 0.55-1.12), deep vein thrombosis prophylaxis 1.13 (95% CI, 0.95-1.34), and continuous sedation 0.92 (95% CI, 0.81-1.06). CONCLUSIONS: In this multicenter study of critically ill adult patients, a prolonged ED stay was not associated with a significant difference in the deployment of evidence-based process of care measures for critically ill adult patients.