(1091) Insights From a Single-Center Study of ICU Evaluations: Analyzing Outcomes and Lessons Learned

Introduction: Early and accurate triaging of patients who may need ICU care is essential to reduce mortality and length of stay (LOS). By identifying patients who are at risk of deterioration and admitting them to the ICU promptly, we can improve their chances of survival and shorten their time in the hospital.

Methods: A single-center retrospective study was done using EMR review to investigate patients who were initially admitted to medical floors with a request for ICU evaluation. The study focused on patients who were eventually found not to require ICU-level care during their initial assessment. The primary outcomes of interest were reevaluation within 48 hours of the initial evaluation, the secondary outcomes were mortality and LOS in the ICU. The differences in mortality and LOS between reevaluated and non-reevaluated patients were studied. The reasons for reevaluation were also analyzed.

Results: The study included 60 patients who were initially determined not to require ICU level of care upon evaluation from 2/1/23 to 30/6/23. 5 patients were excluded from the study due to lack of data. The ICU reevaluated 14/55 patients (25.4%) within 48 hours, and 3/14 patients (21.4%) died in the ICU, 3/41 (7.31%) patients who were not reevaluated died.
The average LOS for reevaluated patients is 8.4 days vs 5.9 days for non-reevaluated patients. The most common cause of reevaluation within 48 hours was hypoxia (6/14), followed by hypotension (5/14) and change in mentation (3/14) in that order.

Conclusions: Based on the findings from this retrospective single-center study, it is evident that the decision not to admit a patient to the ICU following initial evaluation should be approached cautiously. The study revealed that patients who underwent reevaluation within 48 hours after their initial assessment had a higher mortality rate (21.4%) in the ICU compared to those who were not reevaluated. This highlights the importance of careful consideration and ongoing patient assessment, as some patients who initially appear stable may deteriorate rapidly and necessitate ICU-level care. This study emphasizes the need for continued monitoring and management, even after determining that ICU admission is not initially necessary.