The impact of implementing a 24/7 open trauma bed protocol in the surgical intensive care unit on throughput and outcomes

Akash Bhakta, Matthew Bloom, Heather Warren, Nirvi Shah, Tamara Casas, Tyler Ewing, Marko Bukur, Rex Chung, Eric Ley, Daniel Margulies, Darren Malinoski

    Research output: Contribution to journalArticle

    13 Citations (Scopus)

    Abstract

    BACKGROUND: Increased emergency department (ED) length of stay (LOS) has been associated with increased mortality in trauma patients. In 2010,we implemented a 24/7 open trauma bed protocol in our designated trauma intensive care units (TICUs) to facilitate rapid admission from the ED. This required maintenance of a daily bump list and timely transferring of patients out of the TICU.We hypothesized that ED LOS and mortality would decrease after implementation. METHODS: The following data from patients admitted directly from the ED to any ICU were retrospectively compared before (2009) and after (2011) the implementation of a trauma bed protocol at a Level I trauma center: age, sex, Glasgow Coma Scale (GCS) score, shock on admission (systolic blood pressure G 90 mm Hg), mechanism, injury severity scores (Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] score), ED LOS, ICU readmission rates, and mortality. RESULTS: Of the patients, 267 (17%) of 1,611 before and 262 (21%) of 1,266 (p <0.01) after the protocol were admitted directly to the ICU, despite similar characteristics. ED LOS decreased from 4.2 ± 4.0 hours to 3.1 ± 2.1 hours (p <0.01) in all patients as well as patients with an ISS of greater than 24 (3.1 ± 2.5 vs. 2.2 ± 1.6, p G 0.05) and a head AIS score of greater than 2 (4.2 ± 4.9 vs. 3.1 ± 2.0, p = 0.01). Mortality was unchanged for all patients (9% vs. 8%, p = 0.58) but trends toward improved mortality were found after protocol implementation inpatients with an ISS of greater than 24 (30% vs. 13%, p = 0.07) and in patients with a head AIS score of greater than 2 (12% vs. 6%, p = 0.08). A greater proportion of total patients were admitted to a designated TICU after implementation (83% vs. 93%, p G 0.01). ICU readmissions were unchanged (0.3% vs. 1.5%, p = 0.21). CONCLUSION: The implementation of a 24/7 open trauma bed protocol in the surgery ICU was associated with a decreased ED LOS and increased admissions to designated TICUs in all patients. Improved throughput was achieved without increases in ICU readmissions.

    Original languageEnglish (US)
    Pages (from-to)97-101
    Number of pages5
    JournalJournal of Trauma and Acute Care Surgery
    Volume75
    Issue number1
    DOIs
    StatePublished - Jul 2013

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    Critical Care
    Intensive Care Units
    Hospital Emergency Service
    Wounds and Injuries
    Injury Severity Score
    Abbreviated Injury Scale
    Length of Stay
    Mortality
    Craniocerebral Trauma
    Blood Pressure
    Glasgow Coma Scale
    Trauma Centers
    Inpatients
    Shock
    Maintenance

    Keywords

    • Emergency department length of stay
    • Emergency department throughput
    • ICU triage

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    The impact of implementing a 24/7 open trauma bed protocol in the surgical intensive care unit on throughput and outcomes. / Bhakta, Akash; Bloom, Matthew; Warren, Heather; Shah, Nirvi; Casas, Tamara; Ewing, Tyler; Bukur, Marko; Chung, Rex; Ley, Eric; Margulies, Daniel; Malinoski, Darren.

    In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1, 07.2013, p. 97-101.

    Research output: Contribution to journalArticle

    Bhakta, Akash ; Bloom, Matthew ; Warren, Heather ; Shah, Nirvi ; Casas, Tamara ; Ewing, Tyler ; Bukur, Marko ; Chung, Rex ; Ley, Eric ; Margulies, Daniel ; Malinoski, Darren. / The impact of implementing a 24/7 open trauma bed protocol in the surgical intensive care unit on throughput and outcomes. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1. pp. 97-101.
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    abstract = "BACKGROUND: Increased emergency department (ED) length of stay (LOS) has been associated with increased mortality in trauma patients. In 2010,we implemented a 24/7 open trauma bed protocol in our designated trauma intensive care units (TICUs) to facilitate rapid admission from the ED. This required maintenance of a daily bump list and timely transferring of patients out of the TICU.We hypothesized that ED LOS and mortality would decrease after implementation. METHODS: The following data from patients admitted directly from the ED to any ICU were retrospectively compared before (2009) and after (2011) the implementation of a trauma bed protocol at a Level I trauma center: age, sex, Glasgow Coma Scale (GCS) score, shock on admission (systolic blood pressure G 90 mm Hg), mechanism, injury severity scores (Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] score), ED LOS, ICU readmission rates, and mortality. RESULTS: Of the patients, 267 (17{\%}) of 1,611 before and 262 (21{\%}) of 1,266 (p <0.01) after the protocol were admitted directly to the ICU, despite similar characteristics. ED LOS decreased from 4.2 ± 4.0 hours to 3.1 ± 2.1 hours (p <0.01) in all patients as well as patients with an ISS of greater than 24 (3.1 ± 2.5 vs. 2.2 ± 1.6, p G 0.05) and a head AIS score of greater than 2 (4.2 ± 4.9 vs. 3.1 ± 2.0, p = 0.01). Mortality was unchanged for all patients (9{\%} vs. 8{\%}, p = 0.58) but trends toward improved mortality were found after protocol implementation inpatients with an ISS of greater than 24 (30{\%} vs. 13{\%}, p = 0.07) and in patients with a head AIS score of greater than 2 (12{\%} vs. 6{\%}, p = 0.08). A greater proportion of total patients were admitted to a designated TICU after implementation (83{\%} vs. 93{\%}, p G 0.01). ICU readmissions were unchanged (0.3{\%} vs. 1.5{\%}, p = 0.21). CONCLUSION: The implementation of a 24/7 open trauma bed protocol in the surgery ICU was associated with a decreased ED LOS and increased admissions to designated TICUs in all patients. Improved throughput was achieved without increases in ICU readmissions.",
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    AU - Bloom, Matthew

    AU - Warren, Heather

    AU - Shah, Nirvi

    AU - Casas, Tamara

    AU - Ewing, Tyler

    AU - Bukur, Marko

    AU - Chung, Rex

    AU - Ley, Eric

    AU - Margulies, Daniel

    AU - Malinoski, Darren

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    N2 - BACKGROUND: Increased emergency department (ED) length of stay (LOS) has been associated with increased mortality in trauma patients. In 2010,we implemented a 24/7 open trauma bed protocol in our designated trauma intensive care units (TICUs) to facilitate rapid admission from the ED. This required maintenance of a daily bump list and timely transferring of patients out of the TICU.We hypothesized that ED LOS and mortality would decrease after implementation. METHODS: The following data from patients admitted directly from the ED to any ICU were retrospectively compared before (2009) and after (2011) the implementation of a trauma bed protocol at a Level I trauma center: age, sex, Glasgow Coma Scale (GCS) score, shock on admission (systolic blood pressure G 90 mm Hg), mechanism, injury severity scores (Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] score), ED LOS, ICU readmission rates, and mortality. RESULTS: Of the patients, 267 (17%) of 1,611 before and 262 (21%) of 1,266 (p <0.01) after the protocol were admitted directly to the ICU, despite similar characteristics. ED LOS decreased from 4.2 ± 4.0 hours to 3.1 ± 2.1 hours (p <0.01) in all patients as well as patients with an ISS of greater than 24 (3.1 ± 2.5 vs. 2.2 ± 1.6, p G 0.05) and a head AIS score of greater than 2 (4.2 ± 4.9 vs. 3.1 ± 2.0, p = 0.01). Mortality was unchanged for all patients (9% vs. 8%, p = 0.58) but trends toward improved mortality were found after protocol implementation inpatients with an ISS of greater than 24 (30% vs. 13%, p = 0.07) and in patients with a head AIS score of greater than 2 (12% vs. 6%, p = 0.08). A greater proportion of total patients were admitted to a designated TICU after implementation (83% vs. 93%, p G 0.01). ICU readmissions were unchanged (0.3% vs. 1.5%, p = 0.21). CONCLUSION: The implementation of a 24/7 open trauma bed protocol in the surgery ICU was associated with a decreased ED LOS and increased admissions to designated TICUs in all patients. Improved throughput was achieved without increases in ICU readmissions.

    AB - BACKGROUND: Increased emergency department (ED) length of stay (LOS) has been associated with increased mortality in trauma patients. In 2010,we implemented a 24/7 open trauma bed protocol in our designated trauma intensive care units (TICUs) to facilitate rapid admission from the ED. This required maintenance of a daily bump list and timely transferring of patients out of the TICU.We hypothesized that ED LOS and mortality would decrease after implementation. METHODS: The following data from patients admitted directly from the ED to any ICU were retrospectively compared before (2009) and after (2011) the implementation of a trauma bed protocol at a Level I trauma center: age, sex, Glasgow Coma Scale (GCS) score, shock on admission (systolic blood pressure G 90 mm Hg), mechanism, injury severity scores (Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] score), ED LOS, ICU readmission rates, and mortality. RESULTS: Of the patients, 267 (17%) of 1,611 before and 262 (21%) of 1,266 (p <0.01) after the protocol were admitted directly to the ICU, despite similar characteristics. ED LOS decreased from 4.2 ± 4.0 hours to 3.1 ± 2.1 hours (p <0.01) in all patients as well as patients with an ISS of greater than 24 (3.1 ± 2.5 vs. 2.2 ± 1.6, p G 0.05) and a head AIS score of greater than 2 (4.2 ± 4.9 vs. 3.1 ± 2.0, p = 0.01). Mortality was unchanged for all patients (9% vs. 8%, p = 0.58) but trends toward improved mortality were found after protocol implementation inpatients with an ISS of greater than 24 (30% vs. 13%, p = 0.07) and in patients with a head AIS score of greater than 2 (12% vs. 6%, p = 0.08). A greater proportion of total patients were admitted to a designated TICU after implementation (83% vs. 93%, p G 0.01). ICU readmissions were unchanged (0.3% vs. 1.5%, p = 0.21). CONCLUSION: The implementation of a 24/7 open trauma bed protocol in the surgery ICU was associated with a decreased ED LOS and increased admissions to designated TICUs in all patients. Improved throughput was achieved without increases in ICU readmissions.

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    KW - Emergency department throughput

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