Resuscitation Units Speed Up Triage of Critically Ill Patients

An innovative Shock Trauma Center (STC) model helps direct critically ill non-trauma patients to the operating room (OR) or hospital intensive care unit (ICU) as quickly as possible.

Formed at the University of Maryland Medical Center (UMM; Baltimore, USA) in July 2013, the six-bed critical care resuscitation unit (CCRU) is an ICU located inside the STC, with the goal of speeding up adult critical care transfers to UMMC. An attending intensivist staffs the CCRU around the clock and directs patient throughout assessment and stabilization process; CCRU staff and subspecialists collaborate to rapidly evaluate and stabilize patients, and then transfer them to the unit that will best serve their needs.


In the year after the CCRU opened, overall transfers increased 64.5%, and those of critically ill surgical patients increased by 93.6%. For patients who needed surgery, the median arrival times at the CCRU decreased significantly, from 223 to 118 minutes, as did median time to surgery, from about 57 hours to around 18.5 hours. Likewise, median hospital length of stay declined from 17 to 13 days, and even death rates declined from 16.5 % to 14.6%. UMM reported the outcomes of CCRU implementation in a study published on February 23, 2016, in the Journal of the American College of Cardiology (JACC).

“As the population ages and the nature of their illnesses becomes more complex, often involving multiple diseases, the demand for referral centers like UMMC to handle critically ill patients has increased,” said lead author Thomas Scalea, MD, physician-in-chief at the UMMC STC. “Time is a huge variable. There are a number of things—aortic dissection, acute vascular insufficiency, arguably stroke and sepsis—that are all time-related diseases; the clock starts ticking at the time the disease strikes.”

“Community hospitals seek to transfer their most challenging cases to high-volume centers best equipped to provide specialty urgent care,” concluded Dr. Scalea. “The time it takes to get appropriate care can be important when dealing with time-sensitive diseases like stroke, hemorrhage, severe abdominal pain, respiratory failure, and any number of cardiovascular problems. If you burn the time trying to get the patient to the hospital, you have less time to intervene. The more you can truncate the time, the better patients do.”

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University of Maryland Medical Center