title: Maintaining an open trauma intensive care unit bed for rapid admission can be cost-effective.
abstract: BACKGROUND
  In 2012, we implemented a ready open trauma intensive care unit (TICU) bed process. Our hypothesis was that this process would decrease emergency department (ED) length of stay (LOS) in a cost-effective manner without worsening clinical outcomes.
  
  
  METHODS
  We developed a charge nurse without a patient assignment to facilitate this open bed. We also provided team training for early ICU resuscitation. All Level 1 activations admitted directly to the TICU before and after the implementation were examined. Patients taken directly to the operating room from the ED, deaths within 24 hours of admission, and patients with nonsurvivable head injuries were excluded. Cost-effectiveness of the position was examined.
  
  
  RESULTS
  Age (mean [SD], 45.78 [18.71] years), sex (74.7% male), and Injury Severity Score (ISS) (mean [SD], 17.27 [9.26]) were not significantly different. Median ED LOS for the postimplementation group decreased from 230 minutes to 66 minutes (p < 0.001). Median ICU LOS (from 3.29 to 2.98 days, p = 0.13) and total median hospital LOS (from 10.71 to 7.98 days, p = 0.06) decreased but were not statistically significant. Controlling for age, ISS, sex, and mechanism of injury the postimplementation group had a 29% reduction in ICU LOS (2.12 days), a 28% reduction in hospital LOS (4.34), and a 54% reduction in ED LOS (154 minutes). The LOS decreased despite a small increase in ISS (from 15.89 to 18.37). Observed/expected mortality did not differ between the groups, preimplementation/postimplementation of 0.87 and 0.92. Nursing productivity increased one nurse after implementation at a cost of $624 per day. The ICU LOS decrease of 1.6 days at a rate of $1,144 average ICU daily cost of room and board totaled $1,830 per patient. The decreased ICU LOS dollars minus the increase nurse pay resulted in an overall savings of $1,206 per patient.
  
  
  CONCLUSIONS
  Rapid access to the TICU made possible by the charge nurse without a direct assignment and team training has a potential cost savings without adversely affecting patient outcomes.
  
  
  METHODS
  Cost analysis, level III.
authors.affiliation: From the Department of Surgery, Division of Trauma and Acute Care Surgery (L.F., C.T., P.A.K., A.C.B., D.L.D.), University of Kentucky HealthCare, Lexington, Kentucky.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fryman
authors.forename: Cynthia
authors.initials: C
authors.lastname: Talley
authors.forename: Paul
authors.initials: P
authors.lastname: Kearney
authors.forename: Andrew
authors.initials: A
authors.lastname: Bernard
authors.forename: Dan
authors.initials: D
authors.lastname: Davenport
mesh_terms: D000328:Adult; D000368:Aged; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics*; D014947:Wounds and Injuries / Q000191:economics*