(1507) Evidence-Based Practice Checklist for Critically Ill Patients Boarding in the Emergency Department

Introduction: In the United States, emergency department (ED) volumes are rising, leading to ED crowding, which is associated with worse outcomes. Critically ill patients are at particularly high risk when boarding in the ED. Their care may benefit from early implementation of evidence-based interventions. Best practice checklists, used in intensive care units (ICUs) to manage complexity and optimize outcomes, can be adapted to the ED, helping providers deliver high-quality critical care while ICU beds are unavailable. This study used a modified Delphi process to develop consensus on checklist items for critically ill patients boarding in the ED.

Methods: Study personnel recruited a representative Delphi panel of intensivists with training in emergency medicine and critical care. We used a structured literature review to identify candidate items for a best practices checklist. This included a PubMed search of English language articles from 2011-2021 using terms like “critical illness,” “emergency ward,” “ICU,” and “boarding.” Existing best practice checklists and specialty society guidelines were also scrutinized. Panel members rated interventions using a seven-point Likert scale and submitted comments, visible to co-panelists in subsequent rounds. Consensus for inclusion was defined as 80% agreement, achieved after up to three rounds.

Results: The modified Delphi process identified items for a comprehensive, systems-based checklist. Consensus was reached on interventions for post-cardiac arrest management, increased intracranial pressure, intracerebral hemorrhage, respiratory failure, and shock management. Key interventions included vasopressor selection, sedation titration, management of gastrointestinal hemorrhage, electrolyte imbalances, renal and liver failure, coagulopathy, endocrine abnormalities, infectious diseases, and considerations for devices and logistics. This checklist aims to enhance care quality and optimize patient outcomes through the systematic application of best practices at the earliest possible time.

Conclusions: A Delphi process identified evidence-based interventions for a checklist to be used for critically ill patients boarding in the ED awaiting ICU admission. This checklist is expected to improve care quality and patient outcomes through timely and appropriate interventions.