Intermediate care to intensive care triage

A quality improvement project to reduce mortality

David N. Hager, Pranav Chandrashekar, Robert Bradsher, Ali M. Abdel-Halim, Souvik Chatterjee, Melinda Sawyer, Roy G. Brower, Dale M. Needham

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose Medical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur. Methods To improve our triage process, we used a 4Es quality improvement framework (engage, educate, execute, evaluate) to (1) educate residents and fellows regarding principles of triage and (2) facilitate real-time communication between MICU residents conducting triage and supervising physicians. Results Among patients transferred from the IMCU to the MICU during baseline (n = 83;July–December 2012) and intervention phases (n = 94;July–December 2013), unadjusted mortality decreased from 34% to 21% (p = 0.06). After adjusting for severity of illness, admitting diagnosis, and bed availability, the odds of death were lower during the intervention vs. baseline phase (OR 0.33; 95%CI 0.11–0.98). Conclusions Using a structured quality improvement process targeting triage education and increased resident/supervisor communication, we demonstrated reduced mortality among patients transferred from the IMCU to the MICU.

Original languageEnglish (US)
Pages (from-to)282-288
Number of pages7
JournalJournal of Critical Care
Volume42
DOIs
StatePublished - Dec 1 2017

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Triage
Critical Care
Quality Improvement
Intensive Care Units
Mortality
Patient Care
Communication
Patient Acuity
Physicians
Patients' Rooms
Decision Making
Education

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Hager, D. N., Chandrashekar, P., Bradsher, R., Abdel-Halim, A. M., Chatterjee, S., Sawyer, M., ... Needham, D. M. (2017). Intermediate care to intensive care triage: A quality improvement project to reduce mortality. Journal of Critical Care, 42, 282-288. https://doi.org/10.1016/j.jcrc.2017.08.002

Intermediate care to intensive care triage : A quality improvement project to reduce mortality. / Hager, David N.; Chandrashekar, Pranav; Bradsher, Robert; Abdel-Halim, Ali M.; Chatterjee, Souvik; Sawyer, Melinda; Brower, Roy G.; Needham, Dale M.

In: Journal of Critical Care, Vol. 42, 01.12.2017, p. 282-288.

Research output: Contribution to journalArticle

Hager, DN, Chandrashekar, P, Bradsher, R, Abdel-Halim, AM, Chatterjee, S, Sawyer, M, Brower, RG & Needham, DM 2017, 'Intermediate care to intensive care triage: A quality improvement project to reduce mortality', Journal of Critical Care, vol. 42, pp. 282-288. https://doi.org/10.1016/j.jcrc.2017.08.002
Hager, David N. ; Chandrashekar, Pranav ; Bradsher, Robert ; Abdel-Halim, Ali M. ; Chatterjee, Souvik ; Sawyer, Melinda ; Brower, Roy G. ; Needham, Dale M. / Intermediate care to intensive care triage : A quality improvement project to reduce mortality. In: Journal of Critical Care. 2017 ; Vol. 42. pp. 282-288.
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