title: The impact of implementing a 24/7 open trauma bed protocol in the surgical intensive care unit on throughput and outcomes.
abstract: BACKGROUND
  Increased emergency department (ED) length of stay (LOS) has been associated with increased mortality in trauma patients. In 2010, we implemented a 24/7 open trauma bed protocol in our designated trauma intensive care units (TICUs) to facilitate rapid admission from the ED. This required maintenance of a daily bump list and timely transferring of patients out of the TICU. We hypothesized that ED LOS and mortality would decrease after implementation.
  
  
  METHODS
  The following data from patients admitted directly from the ED to any ICU were retrospectively compared before (2009) and after (2011) the implementation of a trauma bed protocol at a Level I trauma center: age, sex, Glasgow Coma Scale (GCS) score, shock on admission (systolic blood pressure < 90 mm Hg), mechanism, injury severity scores (Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] score), ED LOS, ICU readmission rates, and mortality.
  
  
  RESULTS
  Of the patients, 267 (17%) of 1,611 before and 262 (21%) of 1,266 (p < 0.01) after the protocol were admitted directly to the ICU, despite similar characteristics. ED LOS decreased from 4.2 ± 4.0 hours to 3.1 ± 2.1 hours (p < 0.01) in all patients as well as patients with an ISS of greater than 24 (3.1 ± 2.5 vs. 2.2 ± 1.6, p < 0.05) and a head AIS score of greater than 2 (4.2 ± 4.9 vs. 3.1 ± 2.0, p = 0.01). Mortality was unchanged for all patients (9% vs. 8%, p = 0.58) but trends toward improved mortality were found after protocol implementation inpatients with an ISS of greater than 24 (30% vs. 13%, p = 0.07) and in patients with a head AIS score of greater than 2 (12% vs. 6%, p = 0.08). A greater proportion of total patients were admitted to a designated TICU after implementation (83% vs. 93%, p < 0.01). ICU readmissions were unchanged (0.3% vs. 1.5%, p = 0.21).
  
  
  CONCLUSIONS
  The implementation of a 24/7 open trauma bed protocol in the surgery ICU was associated with a decreased ED LOS and increased admissions to designated TICUs in all patients. Improved throughput was achieved without increases in ICU readmissions.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: Midwestern University, Glendale, Arizona, USA.
authors.forename: Akash
authors.initials: A
authors.lastname: Bhakta
authors.forename: Matthew
authors.initials: M
authors.lastname: Bloom
authors.forename: Heather
authors.initials: H
authors.lastname: Warren
authors.forename: Nirvi
authors.initials: N
authors.lastname: Shah
authors.forename: Tamara
authors.initials: T
authors.lastname: Casas
authors.forename: Tyler
authors.initials: T
authors.lastname: Ewing
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Rex
authors.initials: R
authors.lastname: Chung
authors.forename: Eric
authors.initials: E
authors.lastname: Ley
authors.forename: Daniel
authors.initials: D
authors.lastname: Margulies
authors.forename: Darren
authors.initials: D
authors.lastname: Malinoski
mesh_terms: D000328:Adult; D000368:Aged; D001130:Arizona; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006284:Health Plan Implementation; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D055815:Young Adult