• Kerchelle McDowald, Svetlana Direktor, Elizabeth A Hynes, Anna Sahadeo, and Margaret E Rogers.
• 1Pace University, College of Health Professions, New York, USA 2The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence.
• JBI Database System Rev Implement Rep. 2017 Sep 1; 15 (9): 2365-2389.

BackgroundThe increasing volume of adult patients with critical illness entering emergency departments (EDs) burdens the resources of EDs worldwide. This subpopulation faces a high risk of mortality because they require specialized care which many EDs are not yet poised to deliver. An element crucial to delivering care and decreasing the mortality of critically ill patients in the ED is expert collaborative practice across disciplines. Several ED and intensive care unit (ICU) collaborative models exist including: emergency department intensive care units (EDICU) and medical emergency teams (MET).ObjectivesTo evaluate the effectiveness of collaboration between the ED and ICUs on the mortality rates of critically ill adult ED patients.Inclusion Criteria Types Of ParticipantsAdult ED patients, 18 years and over, with non-surgical critical illness meeting the criteria for ICU admission.Types Of Intervention(S)Collaboration between the ED and ICU in the management of critically ill patients in the ED.Types Of StudiesObservational and descriptive studies.Type Of OutcomeAll-cause mortality, including 30-day mortality and in-hospital mortality rates at any time period.Search StrategyThe comprehensive literature search included published and unpublished studies in English from the beginning of each database through November 30, 2016. Databases searched included: PubMed, CINAHL, Embase and Cochrane Central Register of Controlled Trials (CENTRAL). A search for gray literature and electronic hand searching of relevant journals was also performed.Methodological QualityStudies were assessed for methodological quality by four independent reviewers using standardized appraisal tools from the Joanna Briggs Institute (JBI).Data ExtractionData related to the methods, participants, interventions and findings were extracted using a standardized data extraction tool from JBI.Data SynthesisStatistical pooling into a meta-analysis was not possible due to the clinical and methodological heterogeneity in the interventions and outcome measures of the included studies. Results are presented in a narrative form.ResultsThree collaborative models (EDICU, Direct Provider-Provider Collaboration and MET) were identified across five studies. Findings from these studies showed conflicting results. The reviewers were unable to synthesize the evidence to state conclusively the effectiveness of collaborative models on mortality rates of critically ill patients.ConclusionsThere is limited and conflicting evidence related to the effectiveness of EDICU collaborative models on the mortality rates of critically ill patients preventing the development of practice recommendations. This review underscores the need for more research into the benefits of collaborative models between the ED and ICU.

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