Many busy trauma hospitals have equally busy trauma ICUs. Frequently, trauma patients who need critical care are backed up in the emergency department (ED) while awaiting a bed in such cases. This slows ED throughput for other patients, and increases the possibility of an adverse event while waiting for the ICU bed.
The group at the University of Kentucky in Lexington will present an abstract examining the impact of keeping an open bed in the ICU, as well as having a charge nurse in that unit without a patient assignment to help manage bed availability and staffing.
Here are the factoids:
- The study examined highest level trauma activations in the ED requiring ICU admission before implementation of the open bed policy
- 303 patients pre-implementation were compared to 261 patients post-implementation
- The usual demographics were similar for both groups
- Time in the ED decreased from 4:17 to 2:34 after the open bed policy was instituted, which was highly significant
- ICU length of stay (LOS) for patients who were admitted after the policy was in place decreased despite an increase in ISS, but not significantly so
- There was no change in mortality
- There was a cost savings of about $1000 per patient due to increased nursing productivity and the decreased LOS
Bottom line: Making the effort to reserve a bed for an incoming trauma patient at all times seems to be well worth it. I have visited many hospitals with incredible logjams of these patients in the ED. Frequently, this has a disproportionate and negative impact on the throughput of other ED patients. Creating such a policy should serve to improve patient flow (and satisfaction: what family wants to spend hours sitting in the ED?) as well save money.
Reference: Maintaining an open ICU be for rapid access to the trauma intensive care unit is cost effective. Presented at EAST 2015, paper 28.