Locating an intensive care unit inside the emergency department drastically increases survival rates for the sickest patients who arrive at ERs.

The study, published in JAMA Network Open, examined outcomes from the University of Michigan Medical School's emergency department-based ICU. The study was carried out at the Massey Family Critical Care Center, which opened in 2015 and is housed adjacent to University Hospital's main adult emergency room. The unit is intended to receive the sickest and most severely injured patients and is touted as one of the most advanced emergency critical care centers in the nation.

The goal of establishing a critical care area in the ED was to prevent some patients from ever needing to be transferred to an inpatient ICU, study authors said.

“By applying cutting-edge critical care diagnostics and therapies to our sickest patients very early in their presentation to the emergency department, we were able to optimize their care in a way that improved outcomes and often reduced the need for an inpatient ICU admission,” said Dr. Robert Neumar, chair of emergency medicine at the University of Michigan Medical School and the study’s senior author.

Study authors looked at data from all emergency room visits starting in 2012. Visits were divided into two cohorts: pre-critical care unit and post critical care unit. They examined 30-day patient mortality outcomes as well as ICU admission rates among all emergency department patients before and after critical care unit implementation.

Mortality rates decreased from 2.13% before the critical care unit was established to 1.83% after its implementation. ICU admissions also decreased, from 3.2% to 2.7%.

“We were also able to safely decrease ICU admissions because we were able to rapidly initiate that level of care right in our own emergency department,” Neumar said. “In addition to improving patient care within the emergency department, this strategy increased the availability of inpatient critical care resources to other patients already in the hospital or awaiting a transfer to our hospital.”

Researchers say the presence of the critical care unit saved one life for every 333 admissions or one life every 36 hours.

“The time patients have to wait in the emergency department for inpatient critical care resources is increasing nationwide, and longer wait times for intensive care units have been associated with decreased survival rates,” said Dr. Kyle Gunnerson, an associate professor of emergency critical care medicine at the University of Michigan Medical School.

Study authors said they hope more hospitals will follow the University of Michigan's lead.

“We hope this study and the level of care we are able to provide in our (critical care unit) will encourage other health systems to consider implementing an emergency medicine department-based intensive care unit in their own hospital,” said Renee Havey, clinical nurse specialist of the unit and a co-author on the study. “And if they can’t build their own unit at this time, we hope this study offers them strategies they could tailor and use in their own current emergency department setting.”