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

Area of Science:

• Healthcare Management
• Quality Improvement Science
• Patient Flow Optimization

Background:

• Delays in transferring critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU) can negatively impact patient outcomes.
• Inefficiencies in interdepartmental coordination and patient identification contribute to prolonged transfer times.

Purpose of the Study:

• To decrease the time required for transferring critically ill patients from the ED to the MICU.
• To implement and evaluate quality improvement interventions aimed at streamlining the patient transfer process.

Main Methods:

• A prospective, observational study was conducted in a tertiary academic medical center.
• A multidisciplinary team utilized the clinical microsystems approach and Plan-Do-Study-Act methodology to identify and address causes of transfer delays.
• Interventions focused on improving coordination between transport services, respiratory therapy, nursing, and efficient identification of stable MICU patients.

Main Results:

• Transfer time from ED to MICU was reduced from a median of 4.2 hours to 2.2 hours (P<.001).
• Hospital length of stay decreased from 9.9 days to 8.3 days (P<.03).
• Interventions successfully addressed issues of poor coordination and delays in patient identification.

Conclusions:

• A structured quality improvement process involving frontline healthcare professionals can effectively reduce patient transfer delays.
• Multifaceted interventions led to significant reductions in transfer time and hospital length of stay.
• The initiative fostered improved inter-departmental engagement and a more cohesive approach to patient care.