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Reducing Transfer Time from the Acute Inpatient Floors to the MICU: A Quality Improvement Intervention
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A6292 - Reducing Transfer Time from the Acute Inpatient Floors to the MICU: A Quality Improvement Intervention
Author Block: M. K. Ellis, R. Bender, J. Roddy, A. Rusk; Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
Rationale: Reports indicate delays in transfer of care to the medical intensive care unit (MICU) from acute inpatient units result in increased mortality as well as morbidity; including longer hospital stays, longer MICU stays, and worse functional status. An additional concern is efficiently utilizing limited personnel resources in a busy hospital. We aim to facilitate effective transfers during rapid responses by utilizing a risk stratification tool to more efficiently triage transfers to MICU.
Methods: A single-center quality improvement initiative was performed to compare transfer times before and after implementation of a clinical decision tool. During the intervention period, eCART score, a combined-endpoint risk stratification tool, was calculated by housestaff during rapid response team evaluation to aid in decision making to determine if a patient should be transfered to MICU. Pre-intervention and intervention period data were compared using t-test and chi square analysis.
Results: Severity of illness (as evidenced by average eCART score) was similar by t-test analysis during pre-intervention and intervention periods. In the pre-intervention period, 30% of transfers occurred within 20 minutes compared to 50% in the intervention period. 38% of patients with an eCART greater than 17 were transferred to MICU within 20 minutes during the pre-intervention period, compared with 67% during the intervention period, which favors the intervention period.
Conclusions: Reducing delays in time to transfer to higher level of care during rapid responses is expected to be beneficial in optimizing access to critical treatment options, possibly improve outcomes, and reduce system burden on staff who have other responsibilities. Implementing operational measures to target sources of delay is expected to decrease length of time to transfer following rapid responses. In our institution, aiding early diagnosis of clinical instability by implementation of the eCART score utilization at rapid responses demonstrated a favorable trend toward more efficient transfers in patients with declining vital signs. Further efforts could be useful in this area to further identify barriers to efficient transfer and minimize them.
Author Block: M. K. Ellis, R. Bender, J. Roddy, A. Rusk; Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
Rationale: Reports indicate delays in transfer of care to the medical intensive care unit (MICU) from acute inpatient units result in increased mortality as well as morbidity; including longer hospital stays, longer MICU stays, and worse functional status. An additional concern is efficiently utilizing limited personnel resources in a busy hospital. We aim to facilitate effective transfers during rapid responses by utilizing a risk stratification tool to more efficiently triage transfers to MICU.
Methods: A single-center quality improvement initiative was performed to compare transfer times before and after implementation of a clinical decision tool. During the intervention period, eCART score, a combined-endpoint risk stratification tool, was calculated by housestaff during rapid response team evaluation to aid in decision making to determine if a patient should be transfered to MICU. Pre-intervention and intervention period data were compared using t-test and chi square analysis.
Results: Severity of illness (as evidenced by average eCART score) was similar by t-test analysis during pre-intervention and intervention periods. In the pre-intervention period, 30% of transfers occurred within 20 minutes compared to 50% in the intervention period. 38% of patients with an eCART greater than 17 were transferred to MICU within 20 minutes during the pre-intervention period, compared with 67% during the intervention period, which favors the intervention period.
Conclusions: Reducing delays in time to transfer to higher level of care during rapid responses is expected to be beneficial in optimizing access to critical treatment options, possibly improve outcomes, and reduce system burden on staff who have other responsibilities. Implementing operational measures to target sources of delay is expected to decrease length of time to transfer following rapid responses. In our institution, aiding early diagnosis of clinical instability by implementation of the eCART score utilization at rapid responses demonstrated a favorable trend toward more efficient transfers in patients with declining vital signs. Further efforts could be useful in this area to further identify barriers to efficient transfer and minimize them.
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