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SUMMARY
Our 850-bed, academic, tertiary care hospital uses a four-bed dedicated 'shock room' situated between the Departments of Emergency Medicine and Intensive Care to stabilise all acutely ill patients from outside or inside the hospital before transfer to the intensive care unit or other department. Admitted patients stay a maximum of four hours in the shock room. In this article we describe our experiences using this shock room by detailing the demographic data, including time and source of admission, diagnosis and outcome, for the 2514 patients admitted to the shock room in 2006. The most common reasons for admission were cardiac (33%) and neurological (21%) diagnoses. After diagnosis and initial treatment, 54% of patients were transferred to an intensive care unit or a coronary care unit; 2.5% of patients died in the shock room. The shock room provides a useful area of collaboration between emergency department and intensive care unit staff and enables acutely ill patients to be assessed and treated rapidly to optimise outcomes.
Key Words: emergency department, early goal-directed therapy, circulatory shock, emergencies, cardiorespiratory, intensive care unit
Rapid diagnosis and appropriate treatment may decrease morbidity and mortality in critically ill patients1-3. Delayed identification of sick patients and delayed referral to the intensive care unit (ICU) has been associated with poorer outcomes4,5. In patients with severe sepsis or septic shock, Rivers et al1 demonstrated a decreased absolute mortality of 16% in patients who received aggressive resuscitation in the first six hours of emergency department (ED) admission, compared to patients who received standard resuscitation. Kumar et al3 reported that, in patients with septic shock, effective antimicrobial administration within the first hour of documented hypotension was associated with increased survival. Blot et al6 recently reported that early oxygenation assessment (within one hour of hospital admission) in patients with severe community-acquired pneumonia was associated with more rapid antibiotic delivery and better ICU survival. Likewise, the introduction of an algorithm for early management of trauma patients in the emergency room was associated with significantly shorter times to start of life-saving interventions for all patients and with reduced mortality in the most severely injured patients7.
Various options have been proposed to improve the care of critically ill patients outside the ICU walls, including medical emergency teams, expanded...