Abstract
Background
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.
Methods
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).
Results
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.
Conclusion
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.
Key words
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Biography
Sarah Stankiewicz is Trauma Research Assistant, Department of Surgery/Trauma Services, NewYork-Presbyterian Queens, Flushing, NY.
Biography
Craig Larsen is Surgical Resident, Department of Surgery/Trauma Services, New York-Presbyterian Queens, Flushing, NY.
Biography
Francesca Sullivan is Trauma Program Manager, Department of Surgery/Trauma Services, New York-Presbyterian Queens, Flushing, NY.
Biography
Cristina Zullo is Clinical Director, Surgical Intensive Care Unit, New York-Presbyterian Queens, Flushing, NY.
Biography
Suzanne C. Pugh is Director of Emergency Services, NewYork-Presbyterian Queens, Flushing, NY.
Biography
Miroslav Kopp is Attending Physician, Department of Surgery/Trauma Services, New York-Presbyterian Queens, Flushing, NY.
Article info
Publication history
Published online: December 12, 2018
Footnotes
Earn Up to 8.0 Hours. See page 231.
Identification
Copyright
© 2018 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
