Development and Implementation of a New Process to Improve Safety of Urgent Direct Admissions

Direct admission can help reduce emergency department crowding, improve patient satisfaction, and decrease costs, yet there is opportunity to improve standardized processes to do so safely and efficiently. We designed and implemented a new process for urgent direct admission (UDA) at our children's hospital with the SMART (specific, measurable, achievable, relevant, time-bound) aim to increase the number of UDAs between transfer to an intensive care unit (ICU) within 12 hours from direct admission by 50% in 12 months.

We compared unanticipated ICU transfers within 12 hours of admission (outcome) before and after implementing a standardized UDA process. Process measures included number of UDA orders and admissions; balancing measures included rapid response calls within 12 hours of admission.

A total of 2950 UDA orders were placed postimplementation. The average number of UDA admissions between ICU transfers increased from 41.4 to 162.6. Referring clinicians found the process easy to use and preferable to the previous system.

Implementation of a standardized UDA process improved patient safety and efficiency by increasing UDA use and reducing ICU transfers. Key components of the process included the following: clinical criteria for UDA, an electronic health record order including clinical decision support, automatic notification to admissions management, streamlined communication across the patient placement department, the referring clinician, and the family, and a quality metrics dashboard.