All Publications

  • ICU diagnoses associated with increased early emergency department downgrades by a novel emergency critical care program. The American journal of emergency medicine Gupta, P. B., Levin, N. M., Gordon, A. J., Htet, N. N., Lee, J. E., Wilson, J. G., Mitarai, T. 2026; 108: 107-113

    Abstract

    The Emergency Critical Care Program (ECCP) utilizes an ECC attending with dual board certification in Emergency Medicine and Critical Care Medicine providing longitudinal care for MICU patients in the ED after initial resuscitation by the ED team during ECCP hours (2 pm to midnight, weekdays). It is unclear which admission diagnoses of critically ill ED patients are most responsive to the ECCP regarding timely ED downgrades to mitigate ICU overcrowding.This single-center retrospective cohort study included adult ED patients with initial admission orders to the MICU or ECC service between 2015 and 2019. Our primary outcome was the proportion of patients who received a transfer order to a non-ICU service within six hours of their critical care admission order while still in the ED ("Early ED Downgrades"), stratified by admission diagnosis category and adjusted by illness severity. A difference-in-differences analysis compared the change in proportion of "Early ED Downgrades" between the preintervention period (2015-2017) and the intervention period (2017-2019) relative to non-ECCP hours.Our cohort included 1882 patients (mean age 63 years, 53.2% male). The ECCP was associated with a 19.0% (95% CI, 13.0% - 25.0%) increase in severity-adjusted Early ED Downgrades. By diagnosis, significant increases were seen in Respiratory (22.9%; 95% CI, 11.0% - 34.9%), Sepsis (14.2%; 95% CI, 3.0% - 25.5%), and Renal (43.0%; 95% CI, 7.4% - 78.5%) categories. No increases in mortality or transfers to the MICU within 24 h of the downgrades were observed.The ECCP significantly increased Early ED Downgrades, particularly for Respiratory, Sepsis and Renal diagnosis categories, optimizing ICU resources without compromising patient safety.

    View details for DOI 10.1016/j.ajem.2026.05.043

    View details for PubMedID 42302510

  • CRITICAL ESCALATION OF RAPID RESPONSE TEAM ACTIVATION VARIES BY DIAGNOSIS Gupta, P., Moore, A., Lighthall, G., Gordon, A., Ramaswamy, T. LIPPINCOTT WILLIAMS & WILKINS. 2026

    View details for DOI 10.1097/01.ccm.0001188348.68338.bb

    View details for Web of Science ID 001705199800050

  • An unknown (and unexpected) cause of septic shock. Journal of the American College of Emergency Physicians open Kang, A., Gupta, P., Wong, S., Tung, J., Gallegos, M. 2024; 5 (4): e13248

    View details for DOI 10.1002/emp2.13248

    View details for PubMedID 39076254

  • COMMON ICU DIAGNOSES ASSOCIATED WITH EARLY ED DOWNGRADE BY A NOVEL EMERGENCY CRITICAL CARE PROGRAM Gupta, P., Levin, N., Gordon, A., Wilson, J., Mitarai, T. LIPPINCOTT WILLIAMS & WILKINS. 2024

    View details for Web of Science ID 001131541100310

  • COMMON ICU DIAGNOSES ASSOCIATED WITH EARLY ED DOWNGRADE BY A NOVEL EMERGENCY CRITICAL CARE PROGRAM Gupta, P., Levin, N., Gordon, A., Wilson, J., Mitarai, T. LIPPINCOTT WILLIAMS & WILKINS. 2024: S155

    View details for DOI 10.1097/01.ccm.0000999628.89657.4d

    View details for Web of Science ID 001480647000005

  • Use of Point-of-Care Ultrasound by Intensive Care Unit Triage Teams in Evaluating Unstable Patients Outside Intensive Care Units. Cureus Gupta, P. B., Lighthall, G., Htet, N. 2023; 15 (11): e49114

    Abstract

    Introduction Point-of-care ultrasound (POCUS) has become an integral asset in intensive care units (ICUs). However, there is limited literature on the value of POCUS in evaluating deteriorating patients outside the ICU. In this study, we sought to investigate the use and impact of POCUS by ICU triage teams in hospitals outside of the ICU setting. Methods ICU triage fellows were provided a portable ultrasound to use as part of their evaluations during consultations and hospital code activations. Fellows were asked to fill out a survey on how ultrasound was used and its impact on patient management. Free-text data such as reason for ultrasound use, views obtained, clinical impressions before and after ultrasound, and clinical actions were recorded. These data were transcribed and categorized electronically. Results A total of 51 total resuscitations were documented. The most common reason for ICU triage team evaluation was hypotension (53%, N=27). The most common clinical focus for ultrasound use was cardiac assessment (53%, N=27), followed by volume status assessment (35%, N=18). The most common ultrasound views per encounter obtained were parasternal long (82%, N=42), followed by apical four-chamber view (76%, N=39) and subcostal view (75%, N=38). Out of 38 encounters with clinical impressions documented, 79% (N=30) of pre-ultrasound clinical impressions were confirmed by ultrasound use. Of total encounters, 35% (N=18) had a significant clinical action taken based on ultrasound findings (fluid resuscitation, vasopressor initiation, etc.). Conclusions Ultrasound is a valuable tool for patient evaluation in non-ICU wards, especially in confirming clinical impressions and guiding therapeutic actions. Some limitations of this study include reporting bias and incomplete capture of ultrasound use in non-ICU wards.

    View details for DOI 10.7759/cureus.49114

    View details for PubMedID 38125228

    View details for PubMedCentralID PMC10732337

  • USE OF POINT-OF-CARE ULTRASOUND IN EVALUATING UNSTABLE PATIENTS OUTSIDE INTENSIVE CARE UNITS Gupta, P., Lighthall, G., Htet, N. LIPPINCOTT WILLIAMS & WILKINS. 2023: 574

    View details for Web of Science ID 000921450901451

  • ASSOCIATION BETWEEN AN EMERGENCY CRITICAL CARE PROGRAM AND DKA CRITICAL CARE UTILIZATION IN THE ED Gupta, P., Gordon, A., Mitarai, T., Nudelman, M., Kohn, M., Wilson, J. LIPPINCOTT WILLIAMS & WILKINS. 2023: 129

    View details for Web of Science ID 000921450900252