A “Code ICU” expedited review of critically ill patients is associated with reduced emergency department length of stay and duration of mechanical ventilation

•A system of expedited ICU referral of critically ill ED patients is described ('Code ICU').•The 'Code ICU' system was associated with an increased proportion of patients admitted to ICU from ED within 240 min.•Intubated patients had a shorter duration of ventilation and ICU length of stay following 'Code ICU' referral.

PurposeTo examine the effect of a system of expedited review of critically ill patients in the Emergency Department (ED) on ED length of stay (LOS) and Intensive Care Unit (ICU) outcomes.Materials and methodsRetrospective cohort study at a tertiary hospital comparing two 12-month periods before and after implementation of a 'Code ICU' system of expedited review of critically ill patients in the ED. All adult ED to ICU admissions were included. Separate analyses were performed for patients intubated prior to ICU admission.Results622 and 629 patients were included in each time period. During the intervention period more patients had ED LOS < 240 min in both the total [199 (32.0%) vs. 243 (38.6%), P = 0.014; adjusted OR 1.60, 95% CI 1.14-2.25] and intubated cohorts [145 (51.2%) vs. 172 (61.9%), P = 0.011; adjusted OR 1.65, 95% CI 1.16-2.36]. 'Code ICU' intubated patients had a shorter duration of mechanical ventilation, ICU LOS and hospital LOS compared to non-'Code ICU' intubated patients.ConclusionsA system of rapid review of critically ill patients in the ED was associated with reduced ED LOS and improved ICU outcomes.