title: Hospital ward transfer to intensive care unit as a quality marker in emergency medicine.
abstract: BACKGROUND
  Minimizing and preventing adverse events and medical errors in the emergency department (ED) is an ongoing area of quality improvement. Identifying these events remains challenging.
  
  
  OBJECTIVE
  To investigate the utility of tracking patients transferred to the ICU within 24h of admission from the ED as a marker of preventable errors and adverse events.
  
  
  METHODS
  From November 2011 through June 2016, we prospectively collected data for all patients presenting to an urban, tertiary care academic ED. We utilized an automated electronic tracking system to identify ED patients who were admitted to a hospital ward and then transferred to the ICU within 24h. Reviewers screened for possible error or adverse event and if discovered the case was referred to the departmental Quality Assurance (QA) committee for deliberations and consensus agreement.
  
  
  RESULTS
  Of 96,377 ward admissions, 921 (1%) patients were subsequently transferred to the ICU within 24h of ED presentation. Of these 165 (19%) were then referred to the QA committee for review. Total rate of adverse events regardless of whether or not an error occurred was 2.1%, 19/921 (95% CI 1.4% to 3.0%). Medical error on the part of the ED was 2.2%, 20/921 (95% CI 1.5% to 3.1%) and ED Preventable Error in 1.1%, 10/921 (95% CI 0.6% to 1.8%).
  
  
  CONCLUSIONS
  Tracking patients admitted to the hospital from the ED who are transferred to the ICU <24h after admission may be a valuable marker for adverse events and preventable errors in the ED.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States. Electronic address: jsolano@bidmc.harvard.edu.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Solano
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Dubosh
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Anderson
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Wolfe
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, United States.
authors.forename: Shamai A
authors.initials: SA
authors.lastname: Grossman
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D003657:Decision Making; D004635:Emergency Medicine / Q000379:methods* / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D010343:Patient Admission; D010360:Patient Transfer / Q000458:organization & administration*; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D016019:Survival Analysis; D013997:Time Factors