Impact of an Emergency Department–Based Critical Care Unit on Evaluation and Treatment of Sepsis

Timely evaluation and treatment of patients with sepsis has been associated with a decrease in mortality. An emergency department-based critical care and resuscitation unit (CCRU), a novel model in which critical care staffing and equipment is embedded within the ED, may help facilitate timely care for the most time-sensitive clinical presentations. We analyzed our academic medical center’s experience caring for septic patients in our recently created CCRU.

We conducted a retrospective study of adult patients presenting to our center 1/2022 – 4/2024 who met sepsis criteria at triage based on SIRS criteria. Patients were divided into two cohorts, those presenting in the year preceding CCRU implementation (pre-CCRU) and those presenting in the year after implementation (post-CCRU). Patient data was collected from our ED electronic health record (EHR). The primary outcomes of interest were: time to evaluation (blood culture and lactate collection) and treatment (fluid resuscitation and antibiotic initiation). Subgroup analysis was performed to compare patients in the post-CCRU cohort who were triaged to the CCRU (CCRU-triage) vs those triaged to other areas (Main Bay-triage).

Compared to the Pre-CCRU cohort (n=1784), earlier blood culture collection (mean 2.6 vs 2.1 hours, p=0.008) and earlier treatment with fluids (2.6 vs 2.3 hours, p=0.021) and antibiotics (4.0 vs 3.1 hours, p<0.001) occurred in the Post-CCRU cohort (n=1761). There was no difference in time to lactate collection or in-hospital mortality. CCRU-triage patients (n=758) were older (60.0 vs 52.4 years, p<0.001) and had higher rates of several comorbidities including diabetes, heart failure, and obesity compared to Main Bay-triage patients (n=1003). CCRU-triage was associated with earlier blood culture (1.4 vs 3.1 hours, p<0.001) and lactate (0.7 vs 2.7 hours, p<.001) collection and earlier antibiotic administration (2.2 vs 4.5 hours, p<0.001). In-hospital mortality was higher among ED-CCRU patients compared to Main Bay-Triage patients (.07% vs .01%, p<.001).

ED-CCRU implementation was associated with more expedient evaluation and treatment of septic patients as measured by key markers associated with sepsis best-practice care. Triage to the CCRU was associated with higher in hospital mortality, likely reflecting that CCRU patients tended to be older and had more comorbidities at baseline.