title: A quality improvement project to decrease emergency department and medical intensive care unit transfer times.
abstract: OBJECTIVE
  To reduce transfer time of critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU).
  
  
  METHODS
  A prospective, observational study assessing preimplementation and postimplementation of quality improvement interventions in a tertiary academic medical center.
  
  
  METHODS
  A team of frontline health care professional including ED, MICU, and supporting services using the clinical microsystems approach mapped out existing practice patterns, determined causes for delays, and used the Plan-Do-Study-Act to test changes. Measurements and Main Results The team identified multiple issues that contributed to delays. These included poor coordination between transport services, respiratory therapy, and nursing in transferring patients from the ED as well delays in identification and transfer of stable MICU patients. These interventions reduced transfer time from 4.2 (3.4-5.7) hours to 2.2 (1.4-3.1) hours (median [interquartile range]; P<.001). Hospital length of stay decreased from 9.9±9 to 8.3±7 days (P<.03).
  
  
  CONCLUSIONS
  A team made up of frontline health care professionals using a structured quality improvement process and implementing multifaceted, multistage interventions, reduced transfer delays, and length of stay. Added benefits included engagement among members of the 2 microsystems and a more cohesive approach to patient care.
authors.affiliation: Department of Medicine, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Rubin I
authors.initials: RI
authors.lastname: Cohen
authors.affiliation: Department of Nursing, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Heather
authors.initials: H
authors.lastname: Kennedy
authors.affiliation: Department of Nursing, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Amitrano
authors.affiliation: Department of Nursing, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Maryanne
authors.initials: M
authors.lastname: Dillon
authors.affiliation: Department of Medicine, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Sarah
authors.initials: S
authors.lastname: Guigui
authors.affiliation: Department of Nursing, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kanner
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D016638:Critical Illness / Q000628:therapy; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009519:New York City; D010360:Patient Transfer / Q000592:standards* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data*
keywords: Clinical microsystems; MICU; PDSA cycle; Process change; Quality improvement; Transfer time