According to this study:

* Among critically ill patients, a six-hour or longer delay of transfer to the ICU results in a longer stay in the hospital and higher rates of both ICU and in-hospital mortality.

Aggressive treatment during the first 60 minutes ("the golden hour") yields the best outcomes and is now a monitored goal in ischemic stroke, myocardial infarction, septic shock, and multiple trauma.

The present study investigates whether "boarding" critically ill admitted patients in the ED while they wait for ICU beds adversely affects outcomes. Boarding has become a greater problem because of an increase in the volume of critically ill patients presenting to the ED, overcrowding in hospitals and EDs, and a shortage of available staffed ICU beds.

The authors examined data from approximately 120 ICUs at 90 hospitals throughout the United States between January 1, 2000, and December 31, 2003.

It was found that patients waiting six hours or longer in the ED for an ICU bed had longer stays in the hospital and higher rates of both ICU and in-hospital mortality. It's known that critically ill patients have better outcomes when in the presence of specially trained intensivists, when ICU nurse-to-patient ratios are adequate, and when management is closely monitored in well-equipped critical care settings, variables that were not examined in the present study.

C. Cutugno