Summary

Association between intensity of care and discharge destination in patients treated in the emergency department: a cohort study

Andrea Urbina^1-3, Maria-Eulàlia Juvé-Udina^2,4, Jordi Adamuz^1-3, Maribel González-Samartino^2,3,5, Rosa Sánchez-Cabrera^2,3,5, Marta Romero-García^2,3,6

Affiliation of the authors

¹Área de Calidad, Metodología y Conocimiento, Hospital Universitario de Bellvitge, Barcelona, Spain. ²IDIBELL, Instituto de Investigación Biomédica, Barcelona, Spain. ³Facultad de Enfermería, Universidad de Barcelona, Spain. ⁴Institut Català de la Salut, Barcelona, Spain. ⁵Dirección Enfermera. Hospital Universitario de Bellvitge, Barcelona, Spain. ⁶International Research Project for the humanization of Health Care, Proyecto HU-CI.

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Urbina A, Juvé-Udina ME, Adamuz J, González-Samartino M, Sánchez-Cabrera R, Romero-García M. Association between intensity of care and discharge destination in patients treated in the emergency department: a cohort study. Emergencias. 2025;37:335-42

Summary

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).