The Impact of an ICU “Bed Ahead” Policy on ED Length of Stay and Patient Outcomes

DiGiacomo, Jody C.; Angus, L.D. George; Wallace, Raina; Cardozo-Stolberg, Sara; Gerber, Noam; Munnangi, Swapna; Sookraj, Kelley; Skarka, Kathy

doi:10.1097/sla.0000000000002832

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…These studies showed that the expedited transfer of critically ill trauma patients to the ICU is associated with decreased morbidity, hospital length of stay, and mortality. 3…”

Section: Introductionmentioning

confidence: 99%

“…These studies showed that the expedited transfer of critically ill trauma patients to the ICU is associated with decreased morbidity, hospital length of stay, and mortality. 3 While the benefits are evident, efficient transfer is not prioritized nor standardized in most pediatric trauma centers. To our knowledge, there are no studies in the medical literature about the expedited transfer of critically injured pediatric trauma patients.…”

Section: Introductionmentioning

confidence: 99%

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Reducing Emergency Department Length of Stay in Critically Injured Pediatric Trauma Patients: A Quality Improvement Initiative

Castle

Levy

Wilt

et al. 2022

The American Surgeon™

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Background Efficient transfer of adult trauma patients to the intensive care unit (ICU) is associated with decreased emergency department (ED) length of stay (ED LOS) and improved patient outcomes. While well studied in adults, quality improvement (QI) initiatives focused on the rapid transfer of pediatric trauma patients are lacking. We report the effect of institutional system changes directed at expediting the transfer of pediatric trauma patients to the pediatric ICU (PICU). Methods This initiative commenced in 2013. Preliminary data regarding ED LOS for pediatric trauma patients were collected from January through December 2012 as the pre-implementation cohort. Using the plan-do-study-act (PDSA) framework of QI, the first PDSA cycle was implemented in January 2013. In subsequent PDSA cycles, we implemented the mandatory attendance of the PICU charge nurse and the PICU attending physician to all highest-level pediatric trauma activations. Throughout, ED LOS was collected and mapped on a run chart. ED LOS and variance were compared between all cycles of implementation. Results One hundred and fifty-one pediatric patients arrived or were upgraded to the highest-level pediatric trauma activation and admitted to the PICU from 2012 through 2019. We observed a decrease in median ED LOS of 105 minutes between the pre- and post-implementation groups. With each PDSA cycle, we observed a decrease in median ED LOS and variation. Conclusion The inclusion of the PICU charge nurse and attending physician at highest-level pediatric trauma activations facilitated more rapid access to the PICU with decreased ED LOS.

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“…These studies showed that the expedited transfer of critically ill trauma patients to the ICU is associated with decreased morbidity, hospital length of stay, and mortality. 3…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing Emergency Department Length of Stay in Critically Injured Pediatric Trauma Patients: A Quality Improvement Initiative

Castle

Levy

Wilt

et al. 2022

The American Surgeon™

View full text Add to dashboard Cite

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Improving Emergency Department Throughput: Using a Pull Method of Patient Flow

Collins¹

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Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies. PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation? Evidence: A total of 21 studies were identified in the literature that directly support the implementation of this project. Themes from the literature include delays adversely impact patients, ED throughput is directly affected by throughput of inpatient units, and bed ahead programs can improve throughput. Intervention: The primary intervention for this project was implementing a bed ahead process for the host facility. The nurse hand-off process was also altered to improve efficiency. Outcome: The project resulted in an improvement in the ED delay time. During the project, the mean admission delay time was reduced from 184 minutes to 112 minutes. Conclusion: Using a pull methodology effectively enhances ED throughput by reducing delays in the ED admission process.

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The Impact of an ICU “Bed Ahead” Policy on ED Length of Stay and Patient Outcomes

Abstract: Preassigning 1 ICU for the yet to arrive next injured patient decreases ED dwell times, complications, HLOS, and in-hospital mortality.

Cited by 2 publications

References 16 publications

Reducing Emergency Department Length of Stay in Critically Injured Pediatric Trauma Patients: A Quality Improvement Initiative

Reducing Emergency Department Length of Stay in Critically Injured Pediatric Trauma Patients: A Quality Improvement Initiative

Improving Emergency Department Throughput: Using a Pull Method of Patient Flow

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