Maintaining an open trauma intensive care unit bed for rapid admission can be cost-effective

Fryman, Lisa; Talley, Cynthia L.; Kearney, Paul A.; Bernard, Andrew C.; Davenport, Dan

doi:10.1097/ta.0000000000000688

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Before this project, in 2012 our institution began using a rapid admission process for critical trauma patients. 43 Staff familiarity with this process could have promoted expeditious throughput of all trauma patients. Lastly, for trauma patients, the course of hospitalization can be complex and unpredictable, which can cloud understanding of outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Higgins,

Charles,

Fryman

2024

AJN, American Journal of Nursing

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Background: Achieving efficient throughput of patients is a challenge faced by many hospital systems. Factors that can impede efficient throughput include increased ED use, high surgical volumes, lack of available beds, and the complexities of coordinating multiple patient transfers in response to changing care needs. Traditionally, many hospital inpatient units operate via a fixed acuity model, relying on multiple intrahospital transfers to move patients along the care continuum. In contrast, the acuity-adaptable model allows care to occur in the same room despite fluctuations in clinical condition, removing the need for transfer. This model has been shown to be a safe and cost-effective approach to improving throughput in populations with predictable courses of hospitalization, but has been minimally evaluated in other populations, such as patients hospitalized for traumatic injury. Purpose: This quality improvement project aimed to evaluate implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit. Specifically, we sought to examine and compare the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators; and to determine the model's impact on patient transfers for changes in level of care. Methods: This was a retrospective, comparative analysis of 1,371 noncritical trauma patients admitted to a level 1 trauma center before and after the implementation of an acuity-adaptable model. Outcomes of interest included throughput efficiency, resource utilization, and quality of nursing care. Inferential statistics were used to compare patients pre- and postimplementation, and logistic regression analyses were performed to determine the impact of the acuity-adaptable model on patient transfers. Results: Postimplementation, the median ED boarding time was reduced by 6.2 hours, patients more often remained in their assigned room following a change in level of care, more progressive care patient days occurred, fall and hospital-acquired pressure injury index rates decreased respectively by 0.9 and 0.3 occurrences per 1,000 patient days, and patients were more often discharged to home. Logistic regression analyses revealed that under the new model, patients were more than nine times more likely to remain in the same room for care after a change in acuity and 81.6% less likely to change rooms after a change in acuity. An increase of over $11,000 in average daily bed charges occurred postimplementation as a result of increased progressive care–level bed capacity. Conclusions: The implementation of an acuity-adaptable model on a dedicated noncritical trauma unit improved throughput efficiency and resource utilization without sacrificing quality of care. As hospitals continue to face increasing demand for services as well as numerous barriers to meeting such demand, leaders remain challenged to find innovative ways to optimize operational efficiency and resource utilization while ensuring delivery of high-quality care. The findings of this study demonstrate the value of the acuity-adaptable model in achieving these goals in a noncritical trauma care population.

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Section: Discussionmentioning

confidence: 99%

“…The way trauma patients moved through hospitalization should also be acknowledged. Before this project, in 2012 our institution began using a rapid admission process for critical trauma patients 43. Staff familiarity with this process could have promoted expeditious throughput of all trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Higgins,

Charles,

Fryman

2024

AJN, American Journal of Nursing

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“…The initial intervention began in adult patients, but the staff education regarding the goal of efficient transfer to the ICU for critically ill trauma patients crossed over to our pediatric population. 5 The second PDSA intervention aimed to focus on the pediatric patients by mirroring the changes made on the adult side by inviting the PICU charge nurse to attend all pTAR activations. The third PDSA intervention required a PICU attending physician to attend pTAR activations alongside the PICU charge nurse.…”

Section: Interventionmentioning

confidence: 99%

Reducing Emergency Department Length of Stay in Critically Injured Pediatric Trauma Patients: A Quality Improvement Initiative

Castle

Levy

Wilt

et al. 2022

The American Surgeon™

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Background Efficient transfer of adult trauma patients to the intensive care unit (ICU) is associated with decreased emergency department (ED) length of stay (ED LOS) and improved patient outcomes. While well studied in adults, quality improvement (QI) initiatives focused on the rapid transfer of pediatric trauma patients are lacking. We report the effect of institutional system changes directed at expediting the transfer of pediatric trauma patients to the pediatric ICU (PICU). Methods This initiative commenced in 2013. Preliminary data regarding ED LOS for pediatric trauma patients were collected from January through December 2012 as the pre-implementation cohort. Using the plan-do-study-act (PDSA) framework of QI, the first PDSA cycle was implemented in January 2013. In subsequent PDSA cycles, we implemented the mandatory attendance of the PICU charge nurse and the PICU attending physician to all highest-level pediatric trauma activations. Throughout, ED LOS was collected and mapped on a run chart. ED LOS and variance were compared between all cycles of implementation. Results One hundred and fifty-one pediatric patients arrived or were upgraded to the highest-level pediatric trauma activation and admitted to the PICU from 2012 through 2019. We observed a decrease in median ED LOS of 105 minutes between the pre- and post-implementation groups. With each PDSA cycle, we observed a decrease in median ED LOS and variation. Conclusion The inclusion of the PICU charge nurse and attending physician at highest-level pediatric trauma activations facilitated more rapid access to the PICU with decreased ED LOS.

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How should trauma patients be managed in the intensive care unit?

Smith¹,

Reilly²

2020

Evidence-Based Practice of Critical Care

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Maintaining an open trauma intensive care unit bed for rapid admission can be cost-effective

Abstract: Cost analysis, level III.

Cited by 6 publications

References 10 publications

Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care

Reducing Emergency Department Length of Stay in Critically Injured Pediatric Trauma Patients: A Quality Improvement Initiative

How should trauma patients be managed in the intensive care unit?

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