Asociación entre la intensidad de cuidados y el destino de alta en pacientes atendidos en el servicio de urgencias: estudio de cohortes

Abstract

Objective: To analyze the association between the intensity of care and the various discharge destinations of patients treated in the emergency department (ED) of a tertiary referral center. Methods: Observational cohort study. Adult patients treated from June 2021 through June 2022. The main variables were intensity of care, measured using the ATIC (Acute to Intensive Care) patient classification system, and discharge destination from the ED. Data were retrospectively collected from electronic health records. Results: A total of 49,344 patient episodes were included. Patients were distributed across the following care intensity groups: 11.6% in Acute (nurse-to-patient ratio 1:8); 26.4% in Step-Up (ratio 1:6); 46.5% in Intermediate (ratio 1:4); 14.8% in Pre-Intensive (ratio 1:3); and 0.7% in Intensive care (ratio 1:2). Patients in higher-intensity care groups (Pre-Intensive/Intensive) showed a higher rate of adverse discharge outcomes [hospital admission, transfer to intensive care units (ICUs), and death]. The Intermediate group was associated with hospitalization [OR, 1.78 (95%CI, 1.64-1.94)], ICU transfer [OR, 2.07 (95%CI, 1.66-2.58)], and death [OR, 1.9 (95%CI, 1.14-3.19)]. The Pre-Intensive/Intensive group was a risk factor for hospitalization [OR, 3.67 (95%CI, 3.34-4.04)], ICU transfer [OR, 3.6 (95%CI, 2.82-4.61)], and death [OR, 6.19 (95%CI, 3.69-10.39)]. Conclusions: Care intensity groups showed strong associations with discharge destinations from the ED, with patients requiring higher intensity of care (Pre-Intensive/Intensive) being more likely to experience adverse outcomes (hospitalization, ICU transfer, and death).