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

Abstract

ObjectiveTo reduce transfer time of critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU). DesignA prospective, observational study assessing preimplementation and postimplementation of quality improvement interventions in a tertiary academic medical center. InterventionsA 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 ResultsThe 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). ConclusionA 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.