Most emergency departments, including UMHS, do not have the appropriate physical space, equipment, staffing or expertise to provide extended hours of complex critical care at the level required and provided by an intensive care unit. Previous care models addressed this problem with a “top-down” solution with inpatient teams coming to the ED in an attempt to bridge the gap between ED and ICU to begin some components of critical care interventions. This was not a sustainable solution and was frequently unavailable due to the inpatient demands in their home unit, and when available, a lack of familiarity with ED physical plant and staffing and variances in equipment and protocol.
At the University of Michigan Adult Emergency Department, we approached this problem from the “ground up” and in 2012 began to design an innovative solution that revolved around creating a physical space that would meet the needs for comprehensive critical care both now and in the future and building a highly trained team of physicians, physician assistants, nurses and respiratory therapists that would be able to apply contemporary critical care principles and care protocols. The Emergency Critical Care Center (EC3) was established adjacent to the Adult ED to assume care of critical patients post resuscitation and activated for patient care on February 16, 2015.