***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Survival from acute coronary syndromes and major trauma has been shown to depend on timely access to definitive treatment . We sought to identify the significance of intensive care unit ( ICU ) admission delay ( lead-time ) on the outcome of critically-ill medical patients with other diagnoses . METHODS From 1 January 1997 to 31 December 2003 , a prospect i ve cohort study was performed in critically-ill patients requiring mechanical ventilatory support ( MV ) and /or renal replacement therapy ( RRT ) , admitted directly to the Northern Hospital ICU within 24 hours of arrival in the emergency department ( ED ) . Patients were excluded if , a ) they were admitted following surgery , major trauma or transfer from another hospital , or b ) their duration of ICU stay was < 8 hours . Data collected included de-identified patient demographics , final diagnosis , APACHE II mortality risk ( pm ) and lead-time ( i.e. difference between times of entrance to the ED and ICU . ) The primary outcome measure was hospital discharge status . RESULTS Six hundred and nineteen consecutive ICU admissions from the ED met the inclusion criteria and required MV ( n = 557 ) and /or RRT ( n = 162 . ) Non-survivors were older ( median age 73 vs. 54 yrs ) and sicker ( median pm 0.72 vs. 0.23 ) compared with survivors . Multivariate analysis using logistic regression identified lead-time as a significant predictor of mortality ( RR = 1.06 per hour , 95 % CI = 1.01 - 1.10 ; p=0.015 ) in addition to age , diagnosis and illness severity . CONCLUSIONS ICU admission delay ( lead-time ) is associated with a greater mortality-risk in critically ill medical patients requiring MV and /or RRT Introduction When the number of patients who require intensive care is greater than the number of beds available , intensive care unit ( ICU ) entry flow is obstructed . This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need , and in patients that are admitted but are waiting for a bed . The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients . Methods A prospect i ve cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed . Patients for whom a bed was available were immediately admitted ; when no bed was available , patients waited for ICU admission . ICU admission was classified as either delayed or immediate . Confounding variables examined were : age , sex , originating hospital ward , ICU diagnosis , co-morbidity , Acute Physiology and Chronic Health Evaluation ( APACHE ) II score , therapeutic intervention , and Sequential Organ Failure Assessment ( SOFA ) score . All patients were followed until hospital discharge . Results A total of 401 patients were evaluated ; 125 ( 31.2 % ) patients were immediately admitted and 276 ( 68.8 % ) patients had delayed admission . There was a significant increase in ICU mortality rates with a delay in ICU admission ( P = 0.002 ) . The fraction of mortality risk attributable to ICU delay was 30 % ( 95 % confidence interval ( CI ) : 11.2 % to 44.8 % ) . Each hour of waiting was independently associated with a 1.5 % increased risk of ICU death ( hazard ratio ( HR ) : 1.015 ; 95 % CI 1.006 to 1.023 ; P = 0.001 ) . Conclusions There is a significant association between time to admission and survival rates . Early admission to the ICU is more likely to produce positive outcomes STUDY OBJECTIVE We describe the frequency of undesirable events among  patients boarding at a single , urban , tertiary , teaching emergency department ( ED ) through retrospective chart abstract ion . METHODS This was a chart review of all patients admitted during 3 r and omly selected days in 2003 ( n=162 ) to track the frequency of undesirable events such as missed relevant home medications , missed laboratory test results , arrhythmias , or other adverse events . RESULTS One hundred fifty-one charts were abstract ed ( 93.2 % ) ; 27.8 % had an undesirable event , 17.9 % missed a relevant home medication , and 3.3 % had a preventable adverse event . There was a higher frequency of undesirable events among older patients ( 35.9 % , aged > 50 years ; 7.3 % , aged 20 to 49 years ; 28.6 % , aged 0 to 19 years ) and those with more comorbidities ( 44.4 % among Charlson score > or=3 ; 30.8 % score 2 ; 36.1 % score 1 ; 14.5 % score 0 ) . CONCLUSION A substantial frequency of undesirable events occurs while patients board in the ED . These events are more frequent in older patients or those with more comorbidities . Future studies need to compare the rates of undesirable events among patients boarding in the ED versus inpatient units Background The dem and for critical care beds is increasing out of proportion to bed availability . As a result , some critically ill patients are kept in the Emergency Department ( ED boarding ) awaiting bed availability . The aim of our study is to examine the impact of boarding in the ED on the outcome of patients admitted to the Intensive Care Unit(ICU ) . Methods This was a retrospective analysis of ICU data collected prospect ively at King Abdulaziz Medical City , Riyadh from ED between January 2010 and December 2012 and all patients admitted during this time were evaluated for their duration of boarding . Patients were stratified into three groups according to the duration of boarding from ED . Those admitted less than 6 h were classified as Group I , between 6 and 24 h , Group II and more than 24 h as Group III . We carried out multivariate analysis to examine the independent association of boarding time with the outcome adjusting for variables like age , sex , APACHE , Mechanical ventilation , Creatinine , Platelets , INR . Results During the study period , 940 patients were admitted from the ED to ICU , amongst whom 227 ( 25 % ) were admitted to ICU within 6 h , 358 ( 39 % ) within 6–24 h and 355 ( 38 % ) after 24 h. Patients admitted to ICU within 6 h were younger [ 48.7 ± 22.2(group I ) years , 50.6 ± 22.6 ( group II ) , 58.2 ± 20.9 ( group III ) ( P = 0.04)]with less mechanical ventilation duration [ 5.9 ± 8.9 days ( Group I ) , 6.5 ± 8.1 ( Group II ) and 10.6 ± 10.5 ( Group III ) , P = 0.04 ] . There was a significant increase in hospital mortality [ 51(22.5 ) , 104(29.1 ) , 132(37.2 ) , P = 0.0006 ) and the ICU length of stay(LOS ) [ 9.55 days ( Group I ) , 9.8 ( Group II ) and 10.6 ( Group III ) , ( P = 0.002 ) ] with increase in boarding duration . In addition , the delay in admission was an independent risk factor for ICU mortality(OR for group III vs group I is 1.90 , P = 0.04 ) and hospital mortality(OR for group III vs Group I is 2.09 , P = 0.007 ) . Conclusion Boarding in the ED is associated with higher mortality . This data highlights the importance of this phenomenon and suggests the need for urgent measures to reduce boarding and to improve patient flow OBJECTIVE We hypothesized that critically ill patients who remain in the ED for more than 24 hours experience worse outcomes and longer lengths of stay than those transferred to the medical intensive care unit ( MICU ) within 24 hours . METHODS Medical records were examined of all patients admitted to the MICU directly from the ED of a 325-bed community teaching hospital between 2001 and 2002 . RESULTS Of 443 patients , 104 remained in the ED for 24 hours or longer ( ED > or=24 ) before being transferred to the MICU . There were no significant differences in demographic characteristics of the 339 who were in the ED for less than 24 hours ( ED < 24 ) as compared with ED > or=24 . APACHE II scores were 18.9+/-1.0 for a r and om sample of ED<24 and 20.5+/-0.9 for ED > or=24 ( P=.2 ) . Lengths of hospital stay were 10.9+/-0.8 days for ED<24 and 9.8+/-0.9 days for ED > or=24 ( P=.7 ) . Mortality rates were 26.8 % for ED<24 and 26.9 % for ED > or=24 ( P=.5 ) . CONCLUSIONS These data suggest that outcomes of critically ill patients transferred from the ED to our MICU within 24 hours were not better than those who remained in the ED for longer duration s. Larger studies are required to examine this hypothesis OBJECTIVE To assess the impact of delay in emergency department ( ED ) on outcome of critically ill patients admitted to the medical intensive care unit ( MICU ) . Outcome was defined as hospital mortality and as health-related quality of life ( HRQoL ) at 6 months after intensive care assessed by the 15D measure . The 15D is a generic , 15-dimensional , st and ardized measure of HRQoL. We hypothesized that prolonged stay in the ED is related to worse outcome . DESIGN AND SETTING A prospect i ve follow-up cohort study in university hospital . SUBJECTS All consecutive 1675 patients admitted to the MICU between July 2002 and June 2004 . RESULTS The 15D question naire was mailed to all patients alive at 6 months after admission . Of all MICU patients , 64 % were admitted from ED . The mean length of stay in the ED was 6.2 h ( 95%CI 5.9 - 6.5 h ) . The hospital mortality rate was 24.4 % ( 20.0 % in the ED vs. 33.0 % in the non-ED cohort , P < 0.001 ) and it was associated with higher age and degree of physiological derangement at admission . Neither the length of ED stay was associated with hospital mortality ( P = 0.82 ) nor with HRQoL at 6 months after MICU admission ( P = 0.34 ) . Altogether , HRQoL at 6 months was significantly lower compared with the age- and sex-matched general population ( P < 0.001 ) . CONCLUSIONS In a university hospital , the length of ED stay was not associated with the outcome of critically ill medical patients . However , we feel that the effect of ED treatment and delay on outcome and outcome prediction in the critically ill patients deserves further evaluation We hypothesized that a " closed " intensive care unit ( ICU ) was more efficient that an " open " one . ICU admissions were retrospectively analyzed before and after ICU closure at one hospital ; prospect i ve analysis in that ICU with an open ICU nearby was done . Illness severity was gauged by the Mortality Prediction Model ( MPM0 ) . Outcomes included mortality , ICU length of stay ( LOS ) , hospital LOS , and mechanical ventilation ( MV ) . There were no differences in age , MPM0 , and use of MV . ICU and hospital LOS were lower when " closed " ( ICU LOS : prospect i ve 6.1 versus 12.6 d , p < 0.0001 ; retrospective 6.1 versus 9.3 d , p < 0.05 ; hospital LOS : prospect i ve 19.2 versus 33.2 d , p < 0.008 ; retrospective 22.2 versus 31.2 d , p < 0.02 ) . Days on MV  were lower when " closed " ( prospect i ve 2.3 versus 8.5 d , p < 0.0005 ; retrospective 3.3 versus 6.4 d , p < 0.05 ) . Pooled data revealed the following : MV predicted ICU LOS ; ICU organization and MPM0 predicted days on MV ; MV and ICU organization predicted hospital LOS ; mortality predictors were open ICU ( odds ratio [ OR ] 1.5 , p < 0.04 ) , MPM0 ( OR 1.16 for MPM0 increase 0.1 , p < 0.002 ) , and MV ( OR 2.43 , p < 0.0001 ) . We conclude that patient care is more efficient with a closed ICU , and that mortality is not adversely affected OBJECTIVES The authors assessed the effect of emergency department ( ED ) crowding on the nontreatment and delay in treatment for analgesia  in patients who had acute abdominal pain . METHODS This was a secondary analysis of prospect ively enrolled nonpregnant adult patients presenting to an urban teaching ED with abdominal pain during a 9-month period . Each patient had four vali date d crowding measures assigned at triage . Main outcomes were the administration of and delays in time to analgesia .  A delay was defined as waiting more than 1 hour for analgesia . Relative risk ( RR ) regression was used to test the effects of crowding on outcomes . RESULTS A total of 976 abdominal pain patients ( mean [ + /-st and ard deviation ] age = 41 [ + /-16.6 ] years ; 65 % female , 62 % black ) were enrolled , of whom 649 ( 67 % ) received any  analgesia .  Of those treated , 457 ( 7 
    Output:
    
The last remaining study included both ICU and non-ICU subgroups and showed conflicting results , with a positive association for non-ICU patients but no association for ICU patients .
Our systematic review did not find a strong evidence for the association between  ED boarding and IHM but there is a tendency toward this association .