(331) Extensivists? Is There a Need to Station Intensivists in the Emergency Department?

Introduction: Number of patients seen in ED has increased over the years with variations in the severity of complaints. ED is equipped with ED Physicians, nurses, & mid-levels. As EDs often encounter critically ill patients the possibility of stationing an ICU physician in an ED has gained momentum. However, allocating resources requires careful evaluation to determine its feasibility, cost-effectiveness, and impact on patient care. This abstract explores the potential benefits of stationing an ICU physician in ED.

Methods: To test hypothesis, we used CDC data (2020) for the number of all ED visits and patients requiring critical care. We also noted the number of patients needing central line placement, CPR, intubation, and BiPAP/ CPAP. The study was limited by the COVID pandemic, lack of data on CPR utilization & critical care consult requests. 1% of patients left after ED boarding, and fewer than 30 cases in sample data did not meet the National Center for Health Statistics reliability standards.

Results: A total of 131,297 (in thousands) visits were made to ED. Of these, 2.3% needed critical care management. 1.6% needed central line, 0.1% needed CPR, 0.3% intubation, & 0.7% required BiPAP/ CPAP. We did 2-stepped statistical analyses. First, we performed Levene’s Test to establish homogeneity of variance between two groups. The first group comprised patients who required ICU admission, Tele floor, Cath Lab, OR, and/or died in ED. Second, who required central line, foley catheter, intubation, NIPPV, and/or CPR. Our f-ratio value was 0.10585, with p-value 0.75, meaning the homogeneity requirement is met. Once the homogeneity was established, we performed the One-Way ANOVA test for independent measures of the two groups. We also extended our test to include Tukey HSD to control for Type 1 error. Our f-ratio was 0.01372, with p-value 0.90, not significant at p< 0.05. This signifies that despite considering high-end sick patients in ED, the need for critical care was not statistically significant.

Conclusions: Whether the stationing of ICU physicians in ED remains controversial, our study didn't find a significant impact, though it may help. Further studies are needed to understand what factors could be considered to have ICU physicians stationed in the ED and their effect on the mortality rate of ED visits.