(1306) Sustained Impact of Dedicated Intensive Care Beds for Patients During Rapid Response Activations

Introduction: Rapid Response Teams (RRT) routinely respond to clinical deterioration in general ward patients with specialized care needs such as cardiothoracic surgery, transplant, and advanced lung disease. When these patients require escalation to an intensive care unit (ICU), there is a need for transfer to the preferred ICUs that provide specialized care for their clinical needs. These transfers are sometimes delayed or moved to a non-preferred ICU due to capacity constraints. We established protected, dedicated, staffed ICU beds to accommodate the immediate transfer of an acutely deteriorating patient into the preferred ICU. The purpose of this study was to evaluate the sustained impact of these “just-in-time” beds on 1) appropriate service level transfers, 2) hospital length of stay, 3) and hospital mortality.

Methods: All RRT activations over a 40-month period between February 1st, 2021, and June 30th, 2024, were reviewed to identify if transfers were to preferred vs non-preferred ICU. The just-in-time bed was established the first week of October 2022. We compared transfer events in the 20-month pre-intervention period (February 1st, 2021 to September 30th, 2022) with the 20-month post-intervention period (October 1st, 2022 to June 30th, 2024). We analyzed service-level transfers, hospital length of stay, and hospital mortality.

Results: 6,320 RRTs with 2,233 ICU transfers were reviewed over the entire study period. The ICU transfer rate during an RRT was similar in the pre and post-intervention groups (35.6% vs 35.2%). There was a significant increase in preferred ICU transfers from the pre-intervention group (675/971, 69.5%) to the post-intervention group (1,064/1,262, 84.3%, p< 0.01). Length of stay was higher in the non-preferred ICU transfer group (21.26 days) than in the preferred ICU transfer group (21.24 days), but this was not significant. Mortality was higher in the non-preferred ICU transfer group (121/477, 25.4%) than in the preferred ICU transfer group (425/1740, 24.4%) but was not significant.

Conclusions: Establishing dedicated intensive care beds for ICU transfers during an RRT lead to a significant, sustained improvement in on-service ICU transfers. Length of stay and mortality were both higher in the non-preferred ICU transfer group, but these did not reach significance.