OSCARinED: a policy and practice review of an emergency department-based critical care framework for critically ill non-trauma patients

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Abstract
Critically ill non-trauma patients are increasingly managed in the emergency department (ED) for prolonged periods because of hospital crowding, intensive care unit (ICU) capacity constraints, and diagnostic or procedural delays. During this interval, ED teams are required to provide emergency critical care (ECC) that extends beyond initial resuscitation and includes continued organ support, target-based reassessment, prevention of secondary complications, and structured handover. However, unlike trauma and cardiac arrest care, ongoing ECC for boarded non-trauma patients is less consistently supported by ED-specific practice frameworks. This Policy and Practice Review introduces OSCARinED, a pragmatic framework designed to organize ED-based ECC after initial ABCDE stabilization. OSCARinED integrates seven recurrent care domains: oxygenation and ventilation; sedation and analgesia; catecholamines, fluid therapy, and catheter management; anti-infective therapy; risk-adapted positioning and prophylaxis; electrolyte, blood gas, glucose, and nutrition management; and delirium prevention and treatment. The framework links trigger recognition and framework activation to explicit treatment targets, scheduled reassessment, documentation, and disposition planning. OSCARinED is intended as a safety bridge during ED boarding, not as a substitute for ICU admission. Its implementation may support standardization of care, reduce omission-prone tasks, improve handover reliability, and provide a structure for local quality improvement. Future studies should evaluate OSCARinED using implementation-science designs, focusing on process reliability, team performance, patient-centered outcomes, and ED operational endpoints.

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