Patients with life-threatening health conditions who were treated in the innovative Critical Care Resuscitation Unit (CCRU) received faster treatment and had better health outcomes, including a 36 percent lower risk of dying than those who were transferred from the emergency department of a hospital and then evaluated and treated in a traditional intensive care unit, according to a recent study in the Emergency Medicine Magazine conducted by researchers at the University of Maryland School of Medicine (UMSOM).
Critical patients who experience a sudden life-threatening condition such as a stroke, a ruptured aneurysm or a massive pulmonary embolism (blood clot in the lung) are often taken first to the nearest hospital emergency department and then transferred to an institution larger if its condition is considered to be beyond the reach of the hospital’s level of care. However, the evaluation and transfer process of these patients is generally ad hoc and fragmented, resulting in delays in patients receiving urgent care that could save their lives or prevent permanent disability.
To improve access to critical patient care, the University of Maryland Adams Cowley R Shock Trauma Center, in conjunction with the UMSOM Trauma Program, established the CCRU in 2013 as the first resuscitation unit in the nation. The recent study showed for the first time that the use of CCRU not only helped double the number of patients transferred from the emergency departments of other hospitals, but also led to faster access to critical care resources and treatment definitive surgical, which decreased the risk of a patient dying of his disease.
We have provided an important validation of the CCRU model, which shows that it significantly improves patient outcomes. Now that we have the data on the potential to save lives of the CCRU, we hope to see other hospitals creating similar models. “
Quincy Tran, MD, PhD, Assistant Professor of Emergency Medicine at UMSOM who led the study
The study analyzed the medical records of 1565 critically ill patients with 644 treated at the CCRU of the University of Maryland Medical Center (UMMC) during the first year of its operation in 2013. The rest served as control groups that were transferred directly from others. hospitals emergency department to traditional intensive care units in UMMC during 2012 before the opening of the CCRU, and 2013 after the opening of the CCRU.
The researchers found that the average time to enter an intensive care unit after a transfer request was submitted was 108 minutes for patients with CCRU, compared with 158 minutes for the control group of patients who were transferred and treated in 2012 before the CCRU was opened, and 185 minutes for those in 2013. CCRU patients who required emergency surgery received that surgery approximately 3.5 hours on average after arriving at UMMC compared to 6 to 7 hours after Arrival for those in the control group.
After controlling for variations in disease severity and attention, the researchers found that patients with CCRU were 36 percent more likely to survive than those in the control group, which was a statistically significant finding.
“The CCRU follows the model of the highly effective Trauma Resuscitation Unit at the UM R. Adams Cowley Crash Trauma Center. It is based on efficient communication and consultation with referral facilities and in-hospital transportation providers to facilitate the rapid transfer of patients who require specialized care to the University of Maryland Medical Center, “said co-author Daniel Haase, MD, Assistant Professor of Emergency Medicine at UMSOM and Medical Director of CCRU. “Our job is to collaborate with our specialists to offer immediate resuscitation of patients with urgent emergencies.”
The procedures performed at the CCRU include massive blood transfusions, continuous renal replacement therapy (dialysis) for patients with malfunction of the kidneys, continuous monitoring of the brain’s EEG and organ support with a heart-lung machine.
“We are leading the way in critical care medicine by having the first dedicated Critical Care Resuscitation Unit in the nation,” said Dean E. Albert Reece, MD, PhD, MBA, Executive Vice President of Medical Affairs at UMSOM and John Z and Akiko K. Bowers, distinguished teacher. “Having the data to demonstrate better results for patients will convince other hospitals to consider adopting this care model.”
University of Maryland School of Medicine
Tran, Q. K., et al. (2019) The Critical Care Resuscitation Unit transfers more patients from the emergency departments faster and is associated with better results. Emergency Medicine Magazine. doi.org/10.1016/j.jemermed.2019.09.041.