2.50
Hdl Handle:
http://hdl.handle.net/10755/198362
Title:
Moving ICU Admissions out of the Emergency Department in 90 Minutes
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Moving ICU admissions out of the ED in 90 minutes

Purpose: Research suggests that delays with ED patients admitted to the ICU are correlated with increased hospital length of stay, and higher Intensive Care Unit mortality. Improving throughput for the sickest patients is central to many quality and safety markers including the Surviving Sepsis Campaign, decreasing ambulance diversion, reducing ED overcrowding, improving patient satisfaction, and reducing patients who leave without being seen. The goal was to decrease the time it took to move ICU patients out of the ED.

Design: Quality Improvement Project

Setting: Urban teaching, non trauma designated Medical Center, with 247 inpatient beds, 50 ED beds and 16 ICU beds. ED volume has grown from 40, 474 visits in 2004 to over 52,000 visits in 2010 with the same number of inpatient beds and a consistent admission rate.

Participants/Subjects: All patients who were accepted to the ICU service where included in this quality improvement project. The ED / ICU Quality Improvement Team included the ED Director, ED Nurse Manager, ED Physician, Nursing Supervisor, Admitting Manager, ICU Physician Director, ICU Nurse Manager and Clinical Coordinator, ED Quality Nurse, CNO & CMO.

Method: The ED Quality RN reviewed all ICU admissions out of the ED in June of 2009, at which time ICU admits left the ED within 90 minutes 29.7% of the time. An improvement team assembled in September of 2009 and the data collection method was established. Using the MedHost® data base, the time stamp of admit to ICU or “care complete“ and time to “depart ED” was measured for all ICU admissions. The goal was to have 45% of ICU admissions depart the ED within 90 minutes. The improvement team reviewed the process for affecting an admission to the ICU, and there were clear variables along the process points which we revised and streamlined. Every step of the process that created variation and delays was examined and researched for best practice, or evidence to support our existing policies. One change that greatly improved our throughput time was a revision to the intra-hospital transport policy that previously required an ICU resident to assist in transporting out of the ED. The revised policy has guidelines by which the ED team determines the safest transport team, and does not mandate the ICU resident for transporting these patients.

Results/Outcome: From October 2009 to September 2010 the quality measure of ED to ICU admissions that depart the ED within 90 minutes improved from 27.7% to 57.1%. In addition, the average time from ICU decision to admit to departing the ED dropped from 130.4 minutes in October 2009 to 73.1 minutes in September 2010.

Implications: Improving ED throughput, especially for our most resource intense patients, is central to our ability to care for new patients seeking our services. Applying what we have learned to all admitted patients will meet our ED quality objectives.

Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleMoving ICU Admissions out of the Emergency Department in 90 Minutesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198362-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Moving ICU admissions out of the ED in 90 minutes<br/><br/>Purpose: Research suggests that delays with ED patients admitted to the ICU are correlated with increased hospital length of stay, and higher Intensive Care Unit mortality. Improving throughput for the sickest patients is central to many quality and safety markers including the Surviving Sepsis Campaign, decreasing ambulance diversion, reducing ED overcrowding, improving patient satisfaction, and reducing patients who leave without being seen. The goal was to decrease the time it took to move ICU patients out of the ED. <br/><br/>Design: Quality Improvement Project<br/><br/>Setting: Urban teaching, non trauma designated Medical Center, with 247 inpatient beds, 50 ED beds and 16 ICU beds. ED volume has grown from 40, 474 visits in 2004 to over 52,000 visits in 2010 with the same number of inpatient beds and a consistent admission rate. <br/><br/>Participants/Subjects: All patients who were accepted to the ICU service where included in this quality improvement project. The ED / ICU Quality Improvement Team included the ED Director, ED Nurse Manager, ED Physician, Nursing Supervisor, Admitting Manager, ICU Physician Director, ICU Nurse Manager and Clinical Coordinator, ED Quality Nurse, CNO & CMO. <br/><br/>Method: The ED Quality RN reviewed all ICU admissions out of the ED in June of 2009, at which time ICU admits left the ED within 90 minutes 29.7% of the time. An improvement team assembled in September of 2009 and the data collection method was established. Using the MedHost® data base, the time stamp of admit to ICU or “care complete“ and time to “depart ED” was measured for all ICU admissions. The goal was to have 45% of ICU admissions depart the ED within 90 minutes. The improvement team reviewed the process for affecting an admission to the ICU, and there were clear variables along the process points which we revised and streamlined. Every step of the process that created variation and delays was examined and researched for best practice, or evidence to support our existing policies. One change that greatly improved our throughput time was a revision to the intra-hospital transport policy that previously required an ICU resident to assist in transporting out of the ED. The revised policy has guidelines by which the ED team determines the safest transport team, and does not mandate the ICU resident for transporting these patients.<br/><br/>Results/Outcome: From October 2009 to September 2010 the quality measure of ED to ICU admissions that depart the ED within 90 minutes improved from 27.7% to 57.1%. In addition, the average time from ICU decision to admit to departing the ED dropped from 130.4 minutes in October 2009 to 73.1 minutes in September 2010. <br/><br/>Implications: Improving ED throughput, especially for our most resource intense patients, is central to our ability to care for new patients seeking our services. Applying what we have learned to all admitted patients will meet our ED quality objectives. <br/><br/>en_GB
dc.date.available2011-12-21T12:47:31Z-
dc.date.issued2011-12-21T12:47:31Z-
dc.date.accessioned2011-12-21T12:47:31Z-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.