@article{8247,
  author = {David Richardson and Glen Franklin and Ariel Santos and Brian Harbrecht and Dan Danzl and Royce Coleman and Jason Smith and Frank Miller and Kelly McMasters},
  title = {Effective triage can ameliorate the deleterious effects of delayed transfer of trauma patients from the emergency department to the ICU.},
  abstract = {<p><b>BACKGROUND: </b>Emergency department (ED) crowding and delays in care represent a national problem; no large study has examined the impact of such delays in surgical patients. We sought to determine the impact of delayed transfer from the ED on outcomes in trauma/emergency general surgical patients in a center that has developed a policy to triage more critically ill/severely injured patients to earlier ICU admission.</p><p><b>STUDY DESIGN: </b>All trauma patients admitted from January 2005 to April 2007 in a Level I trauma center were divided into a nondelayed (<or=6 hours) group or a delayed (>6 hours) group. Factors associated with their injuries and outcomes were determined from a large prospective database and all deaths were examined by root-cause analysis. Sentinel events were examined in all deaths and among randomly selected survivors.</p><p><b>RESULTS: </b>Among 3,918 patients, ED stay was often prolonged. The nondelayed group spent a mean of 3 hours in the ED compared with 14.6 hours in the delayed group. Patients admitted earlier were more seriously injured and had markedly worse outcomes, with overall mortality of 18% versus 2.3% in the nondelayed and delayed group, respectively. Mortality did not increase with time spent in the ED but, in fact, decreased after 4 hours. Case analysis disclosed two deaths that might have been altered by earlier ICU transfer.</p><p><b>CONCLUSION: </b>Experienced clinicians can effectively triage more critically injured patients to earlier ICU admission and alter associations between ED length of stay and mortality. Hospitals with a large trauma/emergency general surgery caseload resulting in delays in ED throughput should institute policies and procedures for triage of more severely injured patients for early ICU admission and develop a monitoring system to ensure that delays do not adversely affect patient outcomes.</p>},
  year = {2009},
  journal = {J Am Coll Surg},
  volume = {208},
  pages = {671-678; discussion 678-681},
  month = {05/2009},
  issn = {1879-1190},
  doi = {10.1016/j.jamcollsurg.2008.11.018},
  language = {eng},
}