(1560) Centralized Intensive Care Unit Triage Reduces Emergency Department Wait Times

Introduction: Boarding of critically ill patients in the emergency department (ED) and other locations is a ubiquitous problem. Longer waits for intensive care unit (ICU) beds are associated with worse outcomes. In our tertiary care hospital with multiple subspecialty ICUs, we aimed to address this issue by transitioning from a fully decentralized ICU triage process to a partially centralized process.

Methods: In this quality improvement project, the intervention was centralized ICU triage, coordinated by the tele-ICU attending physician, for all patients where a bed would not be available in the first-choice ICU within 30 minutes. Pilot implementation began in July 2023 for ICU admissions from the ED and rapid response team. ED-to-ICU wait times (time from initial bed request until patient arrival in ICU) were compared during seasonality-matched time periods pre-intervention (July-December 2022) and post-intervention (July-December 2023). Survey data were also gathered to ascertain satisfaction among ED clinicians.

Results: During the first year of centralized triage, the triage physician documented assisting with placement of 804 patients, with 66% coming from the ED. There were 1714 ED-to-ICU admissions in the pre-intervention period and 1731 admissions in the post-intervention period. The median ED-to-ICU wait time decreased from 111 min to 93 min (difference 18 min, 95% CI 10 to 25). In the same time frame, the 75th percentile wait time decreased from 205 min to 167 min (difference 38 min, 95% CI 24 to 51), and the 90th percentile wait time decreased from 335 min to 269 min (difference 66 min, 95% CI 40 to 92).

Among 55 ED clinicians who completed the survey, the average rating (scale 1-5, higher better) was 4.4 for impact on workflow and 4.3 for positive effect on patient throughput. Written comments focused on how the new process resulted in streamlined communication.

Conclusions: Centralized triage led to reductions in ED-to-ICU wait times and high satisfaction levels. Wait times following rapid response events could not be measured due to inconsistent timestamps, but anecdotes suggested these reduced as well. Next steps include expansion to the surgical suite. This represents a unique way that tele-critical care can be leveraged to optimize throughput at tertiary care hospitals.