A quality improvement project to decrease emergency department and medical intensive care unit transfer times
Publication Date
2015
Journal Title
J Crit Care
Abstract
OBJECTIVE: To reduce transfer time of critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU). DESIGN: A prospective, observational study assessing preimplementation and postimplementation of quality improvement interventions in a tertiary academic medical center. INTERVENTIONS: A team of frontline health care professional including ED, MICU, and supporting services using the clinical microsystems approach mapped out existing practice patterns, determined causes for delays, and used the Plan-Do-Study-Act to test changes. Measurements and Main Results The team identified multiple issues that contributed to delays. These included poor coordination between transport services, respiratory therapy, and nursing in transferring patients from the ED as well delays in identification and transfer of stable MICU patients. These interventions reduced transfer time from 4.2 (3.4-5.7) hours to 2.2 (1.4-3.1) hours (median [interquartile range]; P < .001). Hospital length of stay decreased from 9.9 +/- 9 to 8.3 +/- 7 days (P < .03). CONCLUSION: A team made up of frontline health care professionals using a structured quality improvement process and implementing multifaceted, multistage interventions, reduced transfer delays, and length of stay. Added benefits included engagement among members of the 2 microsystems and a more cohesive approach to patient care.
Volume Number
30
Issue Number
6
Pages
1331-7
Document Type
Article
EPub Date
2015/09/15
Status
Faculty, Northwell Researcher
Facility
School of Medicine; Northwell Health
Primary Department
General Internal Medicine
PMID
DOI
10.1016/j.jcrc.2015.07.017