title: Hospitalist bed management effecting throughput from the emergency department to the intensive care unit.
abstract: BACKGROUND
  Emergency department (ED) patients in need of an intensive care unit (ICU) admission are very sick. Reducing the length of time to get these patients into ICU beds is associated with improved outcomes.
  
  
  OBJECTIVE
  To reduce the ED length of stay for patients requiring admission to the medical ICU or coronary care unit through the implementation of the "active bed management" (ABM) intervention.
  
  
  METHODS
  A pre-post study design compared data from November 2006 to February 2007 with those from those same months in the prior year at Johns Hopkins Bayview Medical Center in Baltimore. The ABM intervention was carried out by hospitalist physicians and involved: (i) making triage decisions for patients to be admitted and facilitating their transfer from ED to the appropriate care setting and (ii) having proactive management of Department of Medicine resources, which included twice-daily ICU bed management rounds and regular visits to the ED to assess flow.
  
  
  METHODS
  Throughput time for patients presenting to the ED requiring ICU admission was analyzed.
  
  
  RESULTS
  The ED census was higher during the intervention period as compared with the control period, 17 573 versus 16 148 patients. Throughput from ED to coronary care unit and medical ICU beds was reduced by 99 (+/-14) minutes (from 353 minutes in the control period to 254 minutes in the 4 months after the initiation of ABM, P < .0001). Staffing, length of stay, case mix index, ICU transfer rates, and ICU death rates were stable across the 2 periods, all P = not significant.
  
  
  CONCLUSIONS
  Conscientious management of hospital beds, in this case by hospitalist physicians providing ABM, can have a positive and substantial impact on the ED throughput of critically ill patients admitted to ICU beds. This efficiency is likely to positively have impacted on patient satisfaction and safety.
authors.affiliation: Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. ehowell@jhmi.edu
authors.forename: Eric
authors.initials: E
authors.lastname: Howell
authors.forename: Edward
authors.initials: E
authors.lastname: Bessman
authors.forename: Robert
authors.initials: R
authors.lastname: Marshall
authors.forename: Scott
authors.initials: S
authors.lastname: Wright
mesh_terms: D015142:Baltimore; D001509:Bed Occupancy; D003266:Continuity of Patient Care / Q000458:organization & administration; D003325:Coronary Care Units / Q000458:organization & administration; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D020445:Hospitalists / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007902:Length of Stay / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D017748:Time Management / Q000458:organization & administration*