Practice Improvement| Volume 45, ISSUE 2, P144-148, March 2019

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Evaluation of a Practice Improvement Protocol for Patient Transfer From the Emergency Department to the Surgical Intensive Care Unit After a Level I Trauma Activation

Published:December 12, 2018DOI:



      ED boarding is a major issue in many hospitals. ED boarding occurs when there is insufficient hospital capacity to supply inpatient beds for admitted patients. ED boarding is not only a problem because of increased wait times for patients but also because it results in delays in administration of medication, higher rates of complications, and increased mortality.


      In an attempt to improve patient flow and reduce time spent in the emergency department for patients requiring admission to the surgical intensive care unit (SICU), the emergency department, trauma service, and SICU collaborated on a guideline. The protocol developed focused on level I trauma-activated patients who were admitted directly from the emergency department to the SICU. We compared the transfer times before the protocol was initiated (January 1, 2016 to December 31, 2016) with the transfer times after initiation (January 1, 2017 to December 31, 2017) using a paired Students' t-test. Other outcome variables analyzed were hospital and intensive care unit (ICU) length of stay, mortality, complication rate, ventilator days, ventilator-free days, ICU-free days, and injury severity score (ISS).


      The average time to transfer for 2016 was 408.05 minutes (standard deviation 362.76) versus 142.73 minutes (standard deviation 101.90) for 2017. Emergency nurses saved 265.32 minutes per patient, totaling 8,755.56 minutes saved overall. Total amount of nursing hours saved was 146 hours. This was significant at P = 0.0015. No other variables analyzed were significant.


      We reduced the time to transfer from the emergency department to the SICU significantly by implementing a new protocol to expedite this transfer among level I trauma activations. Our protocol shows that a collaborative effort between the main emergency department and SICU can result in expedited care for injured and critically ill patients that not only increases care for the ill but also creates valuable space in a busy emergency department for better patient flow.

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      Sarah Stankiewicz is Trauma Research Assistant, Department of Surgery/Trauma Services, NewYork-Presbyterian Queens, Flushing, NY.


      Craig Larsen is Surgical Resident, Department of Surgery/Trauma Services, New York-Presbyterian Queens, Flushing, NY.


      Francesca Sullivan is Trauma Program Manager, Department of Surgery/Trauma Services, New York-Presbyterian Queens, Flushing, NY.


      Cristina Zullo is Clinical Director, Surgical Intensive Care Unit, New York-Presbyterian Queens, Flushing, NY.


      Suzanne C. Pugh is Director of Emergency Services, NewYork-Presbyterian Queens, Flushing, NY.


      Miroslav Kopp is Attending Physician, Department of Surgery/Trauma Services, New York-Presbyterian Queens, Flushing, NY.