Transition from emergency department to intensive care: the contribution of detailed anamnesis and early imaging to diagnosis and treatment processes

Year 2025, Volume: 6 Issue: 2, 85 - 90, 23.03.2025

Metin Kılınç , Enes Çelik , İbrahim Demir , Semih Aydemir , Hakan Akelma

https://doi.org/10.47582/jompac.1623179

Abstract

Aims: The overcrowding of emergency departments (EDs) is a significant public health issue that diminishes the quality of healthcare services and increases mortality and morbidity rates both nationally and internationally. This study aims to emphasize the importance of detailed anamnesis and early bedside non-invasive imaging (ultrasonography) in patients transferred from the ED to the intensive care unit (ICU). It also addresses the impact of ED overcrowding on healthcare services and proposes solutions to enhance healthcare quality.
Methods: Between June 20, 2024, and November 25, 2024, patients over 18 years admitted to the ICU via the adult ED at Mardin Training and Research Hospital for various reasons were included in the study. A detailed anamnesis and non-invasive ultrasonographic imaging were performed for all ICU-admitted patients.
Results: Among the 242 patients admitted to the ICU, additional findings that influenced treatment decisions were identified in 21 patients through detailed anamnesis and imaging. Of these patients, 11 were male and 10 were female. The most frequent admission diagnoses were traffic accidents [8/21, (38.1%)] and respiratory distress [6/21, (28.6%)].
Conclusion: Our study demonstrates that performing detailed anamnesis and utilizing non-invasive imaging techniques in patients transferred from the ED to the ICU provides critical contributions to diagnosis and treatment. Strategies should be developed to reduce unnecessary ED visits and promote the appropriate use of emergency services.

Keywords

Emergency department, intensive care unit, ultrasonography, detailed anamnesis, echocardiography

Ethical Statement

Approval was obtained from the ethics committee at the Mardin Artuklu University (date: 11/06/2024; approval number: 2024/6-1). Informed consent was obtained from all patients or their first-degree relatives included in the study. All procedures followed were in accordance with the ethical standards (institutional and national) of the committee responsible for human experiments and the 1975 Declaration of Helsinki, revised in 2013.

Supporting Institution

None.

Thanks

None.

Acil servisten yoğun bakıma geçiş: detaylı anamnez ve erken görüntülemenin tanı ve tedavi süreçlerine katkısı

Abstract

Amaç: Acil servislerin (AS) aşırı kalabalık olması, sağlık hizmetlerinin kalitesini düşüren ve hem ulusal hem de uluslararası düzeyde mortalite ve morbidite oranlarını artıran önemli bir halk sağlığı sorunudur. Bu çalışmanın amacı, acil servisten yoğun bakım ünitesine (YBÜ) nakledilen hastalarda ayrıntılı anamnez ve erken yatak başı non-invaziv görüntülemenin (ultrasonografi) önemini vurgulamanın yanı sıra acil servislerdeki aşırı hasta yoğunluğunun sağlık hizmetleri üzerindeki etkisini ele almak ve sağlık hizmetlerinin kalitesini artıracak çözümler sunmaktır.
Gereç ve Yöntemler: 20.06.2024 ile 25.11.2024 tarihleri arasında Mardin Eğitim ve Araştırma Hastanesi erişkin acil servisinden çeşitli nedenlerle anestezi YBÜ'ye kabul edilen 18 yaş üstü hastalar çalışmaya dahil edildi. YBÜ'ye kabul edilen hastalara ayrıntılı anamnez ve non-invaziv ultrasonografik görüntüleme yapıldı.
Bulgular: Anestezi YBÜ'ye kabul edilen 242 hastadan 21'inde ayrıntılı anamnez ve görüntüleme ile hastaların tedavisine katkıda bulunan ek bulgular tespit edildi. Bu hastaların 11'i erkek, 10'u kadındı. En sık başvuru tanıları trafik kazası [8/21, (%38,1)] ve solunum sıkıntısı [6/21, (%28,6)] idi.
Sonuçlar: Çalışmamızda, acil servisten YBÜ'ye transfer edilen hastalarda ayrıntılı anamnez ve non-invaziv görüntüleme tekniklerinin uygulanması tanı ve tedaviye ek katkılar sağlamıştır. Acil servise başvuru oranını azaltmak ve acil servisin uygun kullanımını sağlamak için stratejiler geliştirmenin gerekli olduğuna inanıyoruz.

Keywords

acil servis, yoğun bakım ünitesi, ultrasonografi, detaylı anamnez, ekokardiyografi

References

• Cakmak F, Ikizceli I, Ozturk D, et al. Emergency Department length of stay for critically ill patients followed up in red zone. Signa Vitae. 2021; 17(1):63-68. doi:10.22514/sv.2020.16.0048
• Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126-136. doi:10.1016/j.annemergmed.2008.03.014
• Gill JM, Riley AW. Nonurgent use of hospital emergency departments: urgency from the patient's perspective. J Fam Pract. 1996;42(5):491-496.
• Bakanlığı TS. Sağlık Hizmetleri Genel Müdürlüğü Sağlıkta Kalite ve Akreditasyon Daire Başkanlığı. Sağlıkta kalite standartları hastane versiyon-5 Ankara. Accessed 04 Sep 2024, 2024. https://shgmkalitedb.saglik.gov.tr/TR-12681/arsiv-sks-standartlari.html
• Roland MO, Bartholomew J, Courtenay MJ, Morris RW, Morrell DC. The "five minute" consultation: effect of time constraint on verbal communication. Br Med J. 1986;292(6524):874-876. doi:10.1136/bmj. 292.6524.874
• McQuillan P, Pilkington S, Allan A, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998;316(7148): 1853-1858. doi:10.1136/bmj.316.7148.1853
• Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 1. Chest. 2005;128(2):881-895. doi:10.1378/chest.128.2.881
• Eren G, Hergünsel O, Çukurova Z, Doğan Y, Karakaya O. Yoğun bakımda kardiyopulmoner monitorizasyonda günlük pratiğimizde “yeni” bir araç: transtorasik ekokardiyografi ve akciğer ultrasonu. Turk J Intensive Care. 2012;10(1):13. doi:10.4274/Tybdd.37
• Hwang JJ, Shyu KG, Chen JJ, Tseng YZ, Kuan P, Lien WP. Usefulness of transesophageal echocardiography in the treatment of critically ill patients. Chest. 1993;104(3):861-866. doi:10.1378/chest.104.3.861
• Cook CH, Praba AC, Beery PR, Martin LC. Transthoracic echocardiography is not cost-effective in critically ill surgical patients. J Trauma. 2002;52(2):280-284. doi:10.1097/00005373-200202000-00013
• Stanescu L, Talner LB, Mann FA. Diagnostic errors in polytrauma: a structured review of the recent literature. Emerg Radiol. 2006;12(3):119-123. doi:10.1007/s10140-005-0436-x
• Lee C, Bleetman A. Commonly missed injuries in the accident and emergency department. Trauma. 2004;6(1):41-51. doi:10.1191/ 1460408604ta298oa
• Karaca MA, Erbil B, Özmen MM. Waiting in the emergency room: patient and attendant satisfaction and perception. Eur J Surg Sci. 2011; 2(1):1-4
• Derlet RW. Overcrowding in emergency departments: increased demand and decreased capacity. Ann Emerg Med. 2002;39(4):430-432. doi:10.1067/mem.2002.122707
• Mahony SO, Blank A, Simpson J, et al. Preliminary report of a palliative care and case management project in an emergency department for chronically ill elderly patients. J Urban Health. 2008;85(3):443-451. doi: 10.1007/s11524-008-9257-z
• Beynon T, Gomes B, Murtagh FE, et al. How common are palliative care needs among older people who die in the emergency department? Emerg Med J. 2011;28(6):491-495. doi:10.1136/emj.2009.090019
• Mullins PM, Goyal M, Pines JM. National growth in intensive care unit admissions from emergency departments in the United States from 2002 to 2009. Acad Emerg Med. 2013;20(5):479-486. doi:10.1111/acem.12134
• Şahin S, Boydak B, Savaş S. Acil servise başvuran 65 yaş ve üzeri hastaların özellikleri. Akad Geiartri. 2011;3(3):41-46.
• Şahin S, Boydak B, Savaş S, Yalçın M, Akçiçek F. Acil servise başvuran 65 yaş ve üzeri hastaların özellikleri. Akademik Geriatri Dergisi. 2011; 3(3):41-46.
• Goldhill DR, Sumner A. Outcome of intensive care patients in a group of British intensive care units. Crit Care Med 1998;26(8):1337-1345. doi: 10.1097/00003246-199808000-00017
• Fassier T, Duclos A, Abbas-Chorfa F, et al. Elderly patients hospitalized in the ICU in France: a population-based study using secondary data from the national hospital discharge database. J Eval Clin Pract. 2016; 22(3):378-386. doi:10.1111/jep.12497
• Flaatten H, De Lange DW, Morandi A, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (>/= 80 years). Intensive Care Med. 2017;43(12):1820-1828. doi:10.1007/s00134-01 7-4940-8
• Kachalia A, Gandhi TK, Puopolo AL, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007;49(2):196-205. doi:10.1016/j.annemergmed.2006.06.035
• Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma. 1990;30(6):666-669.
• Houshian S, Larsen MS, Holm C. Missed injuries in a level I trauma center. J Trauma. 2002;52(4):715-719. doi:10.1097/00005373-200204000-00018
• Chan RN, Ainscow D, Sikorski JM. Diagnostic failures in the multiple injured. J Trauma. 1980;20(8):684-687. doi:10.1097/00005373-198008000-00009
• Ala-Kokko TI, Ohtonen P, Koskenkari J, et al. Improved outcome after trauma care in university-level intensive care units. Acta Anaesthesiol Scand. 2009; 53(10):1251-1256. doi:10.1111/j.1399-6576.2009.02072.x
• Halsted MJ, Kumar H, Paquin JJ, et al. Diagnostic errors by radiology residents in interpreting pediatric radiographs in an emergency setting. Pediatr Radiol. 2004;34(4):331-336. doi:10.1007/s00247-004-1150-7
• Karcz A, Korn R, Burke MC, et al. Malpractice claims against emergency physicians in Massachusetts: 1975-1993. Am J Emerg Med. 1996;14(4): 341-345. doi:10.1016/S0735-6757(96)90044-3
• Guly HR. Diagnostic errors in an accident and emergency department. Emerg Med J. 2001;18(4):263-269. doi:10.1136/emj.18.4.263
• Razzaq QM. Use of the 'sliding lung sign' in emergency bedside ultrasound. Eur J Emerg Med. 2008;15(4):238-241. doi:10.1097/MEJ. 0b013e3282f4d15b
• García-Gigorro R, de la Cruz Vigo F, Andrés-Esteban EM, et al. Impact on patient outcome of emergency department length of stay prior to ICU admission. Med Intensiva. 2017;41(4):201-208. doi:10.1016/j.medin.2016. 05.008