title: An Interdepartmental Care Model to Expedite Admission from the Emergency Department to the Medical ICU.
abstract: BACKGROUND
  Early evidence suggests that multidisciplinary programs designed to expedite transfer from the emergency department (ED) may decrease boarding times. However, few models exist that provide effective ways to improve the ED- to-ICU transition process. In 2012 Christiana Care Health System (Newark, Delaware) created and implemented an interdepartmental program designed to expedite the transition of care from the ED to the medical ICU (MICU).
  
  
  METHODS
  This quasi-experimental study compared ED length of stay (LOS), MICU LOS, and overall hospital LOS before and after the MICU Alert Team (MAT) intervention program. The MAT consisted of a MICU nurse and physician assistant, with oversight by a MICU attending physician. The ED triggered the MAT after patients were stabilized and determined to require MICU admission. Following bedside face-to-face hand off, the MAT providers then assumed responsibly of a patient's care. If no MICU bed was available, the MAT cared for patients in the ED until they were transferred to the MICU.
  
  
  RESULTS
  ED LOS was reduced by 30% (2.6 hours) from baseline (p < .001). There were no significant differences in MICU LOS (p = .26), overall hospital LOS (p = .43), or mortality (p = .59). ED LOS was shortened (p < .001) at each increasing level of MICU bed availability (31% when 0 MICU beds available; 26% when 1 or more MICU beds available). Time series analysis identified a 1.5-hour drop in ED LOS (p = .02) for patients transferred from the MICU immediately following intervention implementation and was sustained over time.
  
  
  CONCLUSIONS
  Early outcomes demonstrate that the MAT intervention can reduce ED LOS for critically ill patients. Additional studies should determine optimal approaches to improve clinical outcomes.
authors.affiliation: Christiana Care Quality Partners, and Research Scholar, Value Institute, Christiana Care Health System, Newark, Delaware, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Elliott
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Williams
authors.forename: Pan
authors.initials: P
authors.lastname: Wu
authors.forename: Hemant V
authors.initials: HV
authors.lastname: Kher
authors.forename: Barret
authors.initials: B
authors.lastname: Michalec
authors.forename: Natalie
authors.initials: N
authors.lastname: Reinbold
authors.forename: Christian M
authors.initials: CM
authors.lastname: Coletti
authors.forename: Badrish J
authors.initials: BJ
authors.lastname: Patel
authors.forename: Robert M
authors.initials: RM
authors.lastname: Dressler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer / Q000458:organization & administration*; D013997:Time Factors