A quality improvement project to decrease emergency department and medical intensive care unit transfer times

Cohen, Rubin I.; Kennedy, Heather; Amitrano, Bernadette; Dillon, Maryanne; Guigui, S.; Kanner, Andrew A.

doi:10.1016/j.jcrc.2015.07.017

Cited by 6 publications

(5 citation statements)

References 19 publications

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“…Cohen et al reported that training of two microsystems, the ED team and the ICU team, and an efficient team approach reduced transfer time by 48%. 13 …”

Section: Discussionmentioning

confidence: 99%

Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit

Arora,

Sahni,

Jain

et al. 2023

Indian Journal of Critical Care Medicine

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A bstract Background and aim Delay in the transfer of critically ill patients from the emergency department (ED) to intensive care units (ICUs) may worsen clinical outcomes. This prospective, observational study was done to find the incidence of delayed transfer. Materials and methods After approval from the institute ethics committee and written informed consent, all patients admitted to ICU from ED over 6 months were divided into groups I and II as patients getting transferred to ICU within 30 minutes of the decision or not, respectively. The factors affecting the immediate transfer and clinical outcome of all patients were noted. Monthly feedback was given to the ED team. Results Out of 52 ICU admissions from ED, 35 (67.3%) patients were not transferred within 30 minutes, and the most frequent factor preventing immediate transfer was ED-related (54%). A statistically significant difference was found in acute physiology and chronic health evaluation (APACHE II) score, clinical deterioration during transfer, longer duration of mechanical ventilation and length of stay, and higher mortality with patients transferred immediately to ICU. A reduction of 42.6% was noted in transfer time from the first month to the last month of study. Conclusion The incidence of delayed transfer of patients from ED to ICU was 67.3% with ED-related factors being the most frequent cause of delay (54.2%). How to cite this article Bosco S, Sahni N, Jain A, Arora P, Raj V, Yaddanapudi L. Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit. Indian J Crit Care Med 2023;27(8):580–582.

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“…Cohen et al reported that training of two microsystems, the ED team and the ICU team, and an efficient team approach reduced transfer time by 48%. 13 …”

Section: Discussionmentioning

confidence: 99%

Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit

Arora,

Sahni,

Jain

et al. 2023

Indian Journal of Critical Care Medicine

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“…Development of ICU admission prioritization guidelines and trauma standardization efforts are likely responsible for these improvements. 4,22,[24][25][26][27][28][29][30] The current pandemic forces intensivists to make difficult decisions in how to best use critical care resources. These data, in addition to triage scores and early warning systems may help support intensivists in the ICU admission prioritization decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Length of Stay and Mortality in Critically Injured Patients

Stey

Kanzaria

Dudley

et al. 2021

J Intensive Care Med

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Objective: Multicenter data from 2 decades ago demonstrated that critically ill and injured patients spending more than 6 hours in the emergency department (ED) before transfer to the intensive care unit (ICU) had higher mortality rates. A contemporary analysis of ED length of stay in critically injured patients at American College of Surgeons’ Trauma Quality Improvement Program (ACS-TQIP) centers was performed to test whether prolonged ED length of stay is still associated with mortality. Methods: This was an observational cohort study of critically injured patients admitted directly to ICU from the ED in ACS-TQIP centers from 2010-2015. Spending more than 6 hours in the ED was defined as prolonged ED length of stay. Patients with prolonged ED length of stay were matched to those with non-prolonged ED length of stay and mortality was compared. Main Results: A total of 113,097 patients were directly admitted from the ED to the ICU following injury. The median ED length of stay was 167 minutes. Prolonged ED length of stay occurred in 15,279 (13.5%) of patients. Women accounted for 29.4% of patients with prolonged ED length of stay but only 25.8% of patients with non-prolonged ED length of stay, P < 0.0001. Mortality rates were similar after matching—4.5% among patients with prolonged ED length of stay versus 4.2% among matched controls. Multivariable logistic regression of the matched cohorts demonstrated prolonged ED length of stay was not associated with mortality. However, women had higher adjusted mortality compared to men Odds Ratio = 1.41, 95% Confidence Interval 1.28 -1.61, P < 0.0001. Conclusion: Prolonged ED length of stay is no longer associated with mortality among critically injured patients. Women are more likely to have prolonged ED length of stay and mortality.

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“…Existing hospital resources can be used to improve patient flow management by improving communication about patients' care plans and discharge needs [81]. Other initiatives include the introduction of software products such as bed management systems and electronic dashboards [81][82][83][84][85][86][87]; the establishment of a bed management team [86]; regular bed management/safety huddle meetings [81-85, 87, 88]; the appointment of a transfer coordinator/team [48,82,89]; and expedited discharge times [82]. Moreover, introducing a logistic management program with a dedicated logistics manager to coordinate patients improved patient assessment time and length of stay metrics in an ED [82].…”

Section: Virtual Control Centresmentioning

confidence: 99%

“…Several studies noted that a system-wide approach is needed to improve patient management, while taking into account competing hospital priorities [11,41,44,45,49,55,82,84,90,91]. The articles relied on various systems-based frameworks for investigating patient management, including the concept of High Reliability Organisations (HRO) [16,43]; lean management models [23,83,86,90]; Plan-Do-Study-Act [49,75,85,90]; quality improvement (QI) [83,85,92,93]; process mapping/tracking [78,81,83,85]; Ishikawa Diagrams [78,83]; and Design-Measure-Analyse-Improve-Control (DMAIC) [83]. One paper described a systems engineering approach to analyse and maximise capacity in one health system for BAU, which resulted in the establishment of a centralised capacity command center [41].…”

Section: Systems-wide and Human Factors Approachesmentioning

confidence: 99%

Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review

Paterson,

Chari,

McCormack

et al. 2024

J Med Syst

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Over the past decade, healthcare systems have started to establish control centres to manage patient flow, with a view to removing delays and increasing the quality of care. Such centres—here dubbed Healthcare Capacity Command/Coordination Centres (HCCCs)—are a challenge to design and operate. Broad-ranging surveys of HCCCs have been lacking, and design for their human users is only starting to be addressed. In this review we identified 73 papers describing different kinds of HCCCs, classifying them according to whether they describe virtual or physical control centres, the kinds of situations they handle, and the different levels of Rasmussen’s [1] risk management framework that they integrate. Most of the papers (71%) describe physical HCCCs established as control centres, whereas 29% of the papers describe virtual HCCCs staffed by stakeholders in separate locations. Principal functions of the HCCCs described are categorised as business as usual (BAU) (48%), surge management (15%), emergency response (18%), and mass casualty management (19%). The organisation layers that the HCCCs incorporate are classified according to the risk management framework; HCCCs managing BAU involve lower levels of the framework, whereas HCCCs handling the more emergent functions involve all levels. Major challenges confronting HCCCs include the dissemination of information about healthcare system status, and the management of perspectives and goals from different parts of the healthcare system. HCCCs that take the form of physical control centres are just starting to be analysed using human factors principles that will make staff more effective and productive at managing patient flow.

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A quality improvement project to decrease emergency department and medical intensive care unit transfer times

Cited by 6 publications

References 19 publications

Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit

Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit

Emergency Department Length of Stay and Mortality in Critically Injured Patients

Application of a Human Factors Systems Approach to Healthcare Control Centres for Managing Patient Flow: A Scoping Review

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