Reduction of early inpatient transfers and rapid response team calls after implementation of an emergency department intake huddle process

BMJ Open Quality

article

Sarah Hermanson¹  Scott Osborn²  Christin Gordanier³  Evan Coates⁴  Barbara Williams¹  Craig Blackmore¹ 

[1] Center for Health Care Improvement Science , Virginia Mason Medical Center;Emergency Medicine , Virginia Mason Medical Center;Hospital Nursing , Virginia Mason Medical Center;Hospital Medicine , Virginia Mason Medical Center

关键词: healthcare quality improvement;    emergency department;    critical care;    continuous quality improvement;    quality improvement;   

DOI  :  10.1136/bmjoq-2019-000862

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Patients admitted to the hospital and requiring a subsequent transfer to a higher level of care have increased morbidity, mortality and length of stay compared with patients who do not require a transfer during their hospital stay. We identified that a high number of patients admitted to our intermediate care (IMC) unit required a rapid response team (RRT) call and an early (<24 hours) transfer to the intensive care unit (ICU). A quality improvement project was initiated with the goal to reduce subsequent early transfers to the ICU and RRT calls. We started by focusing on IMC patients, implementing acuity-based nursing assignments and standardised daily nursing rounds in the IMC aiming to reduce early patient transfers to the ICU. Then, we expanded to all patients admitted to a hospital medical unit from the emergency department (ED), targeting patients with gastrointestinal (GI) bleed and sepsis who were at a higher risk for early transfer to the ICU. We then created an ED intake huddle process that over time was refined to target patients with SIRS criteria with an elevated serum lactic acid level greater than 2.0 mmol/L or a GI bleed with a haematocrit value less than 24%. These interventions resulted in an 10.8 percentage points (31.7% (225/710) to 20.9% (369/1764)) decrease in the early transfers to the ICU for all hospital medicine patients admitted to the hospital from the ED. Mean RRT calls/day decreased by 17%, from 3.0 mean calls/day preintervention to 2.5 mean calls/day postintervention. These quality improvement initiatives have sustained successful outcomes for over 6 years due to integrating enhanced team communication as organisational cultural norm that has become the standard.healthcare quality improvementemergency departmentcritical carecontinuous quality improvementquality improvementhttp://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

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