Quality Improvement Curriculum for Intensive Care Unit Upgrades.

Area of Science:

• Medical Education
• Emergency Medicine
• Critical Care

Background:

• Patients transferred from the emergency department (ED) to the intensive care unit (ICU) can decompensate.
• An emergency medicine (EM) curriculum reviewing ICU upgrade cases may enhance resident knowledge of critical illness and patient disposition.
• Early identification and ICU admission can improve patient outcomes.

Purpose of the Study:

• To evaluate the effectiveness of a resident quality improvement curriculum focused on ICU upgrade cases.
• To compare ICU upgrade rates between EM residents who participated in the curriculum and those who did not.

Main Methods:

• Retrospective analysis of 242 ICU upgrade cases from July 2019 to October 2021.
• Comparison of postgraduate year 2 (PGY-2) EM residents who completed the ICU upgrades curriculum versus those who did not.
• Analysis of reasons for ICU upgrades.

Main Results:

• Post-curriculum residents had an average of 1.0 ICU upgrades per resident, compared to 1.54 for pre-curriculum residents (P=0.12).
• No statistically significant difference in ICU upgrades was observed, but a trend toward fewer upgrades for curriculum participants was noted.
• Common reasons for ICU upgrades included respiratory distress, hypotension, and declining mental status.

Conclusions:

• The ICU upgrades curriculum did not significantly reduce ICU transfers in this study, possibly due to underpowering.
• A trend toward fewer ICU upgrades suggests potential curriculum benefits.
• Reassessment of vital signs and mental status in the ED is crucial for appropriate patient disposition.