Effectiveness of collaboration between emergency department and intensive care unit teams on mortality rates of patients presenting with critical illness: a systematic review.

BACKGROUND: The increasing volume of adult patients with critical illness entering emergency departments (EDs) burdens the resources of EDs worldwide. This subpopulation faces a high risk of mortality because they require specialized care which many EDs are not yet poised to deliver. An element crucial to delivering care and decreasing the mortality of critically ill patients in the ED is expert collaborative practice across disciplines. Several ED and intensive care unit (ICU) collaborative models exist including: emergency department intensive care units (EDICU) and medical emergency teams (MET).

OBJECTIVES: To evaluate the effectiveness of collaboration between the ED and ICUs on the mortality rates of critically ill adult ED patients.

INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adult ED patients, 18 years and over, with non-surgical critical illness meeting the criteria for ICU admission.

TYPES OF INTERVENTION(S): Collaboration between the ED and ICU in the management of critically ill patients in the ED.

TYPES OF STUDIES: Observational and descriptive studies.

TYPE OF OUTCOME: All-cause mortality, including 30-day mortality and in-hospital mortality rates at any time period.

SEARCH STRATEGY: The comprehensive literature search included published and unpublished studies in English from the beginning of each database through November 30, 2016. Databases searched included: PubMed, CINAHL, Embase and Cochrane Central Register of Controlled Trials (CENTRAL). A search for gray literature and electronic hand searching of relevant journals was also performed.

METHODOLOGICAL QUALITY: Studies were assessed for methodological quality by four independent reviewers using standardized appraisal tools from the Joanna Briggs Institute (JBI).

DATA EXTRACTION: Data related to the methods, participants, interventions and findings were extracted using a standardized data extraction tool from JBI.

DATA SYNTHESIS: Statistical pooling into a meta-analysis was not possible due to the clinical and methodological heterogeneity in the interventions and outcome measures of the included studies. Results are presented in a narrative form.

RESULTS: Three collaborative models (EDICU, Direct Provider-Provider Collaboration and MET) were identified across five studies. Findings from these studies showed conflicting results. The reviewers were unable to synthesize the evidence to state conclusively the effectiveness of collaborative models on mortality rates of critically ill patients.

CONCLUSIONS: There is limited and conflicting evidence related to the effectiveness of EDICU collaborative models on the mortality rates of critically ill patients preventing the development of practice recommendations. This review underscores the need for more research into the benefits of collaborative models between the ED and ICU.