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

26365001

DOI

10.1016/j.jcrc.2015.07.017

For the public and Northwell Health campuses

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