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A nurse practitioner-led quality improvement initiative at a Tennessee hospital cut the time critically ill emergency department patients waited for specialized critical care involvement by more than 50%, according to a new study published in AACN Advanced Critical Care.
The findings offer a practical strategy for emergency nurses, critical care nurses, nurse practitioners, and hospital leaders seeking to improve care for critically ill patients awaiting an intensive care unit (ICU) bed.
Earlier Critical Care Starts in the Emergency Department
The project was conducted at Ascension Saint Thomas West Hospital in Nashville, where pulmonary critical care nurse practitioners developed a Medical Intensive Care Unit Admission Management Process (MAMP) for patients admitted directly from the emergency department to the hospital’s 28-bed medical ICU. The process was developed during the hospital’s transition to a closed ICU model.
Under the closed ICU model, an intensivist-led team assumed responsibility for managing critically ill patients from admission through discharge. The new workflow clarified responsibilities between emergency department and ICU teams while allowing critical care consultations and initial patient assessments to begin before patients were physically transferred to the ICU.
This allowed patients to receive ICU-level expertise even when an ICU bed was not immediately available.
Wait Time for Critical Care Team Involvement Cut by More Than Half
After implementing the new admission process, the average time patients waited for critical care team involvement dropped from 113.9 minutes to 56 minutes, a 50.8% reduction.
“The updated admissions process alleviates any uncertainty about which medical team is managing a patient’s care and ensures that definitive care and assessment by the critical care team aren’t hampered by delays in transfer to the MICU,” said Whitney Haley, DNP, APRN, AGACNP-BC, pulmonary critical care nurse practitioner at Ascension Saint Thomas West Hospital.
“In essence, it brings MICU-level expertise to the patient during a high-risk transition period.”
Better Coordination May Improve ICU Resource Use
Average ICU length of stay increased from 2.8 days to 3.4 days, while the percentage of patients spending fewer than 24 hours in the ICU decreased from 23.3% to 19.2%.
According to the authors, providing critical care expertise while patients remained in the emergency department allowed the team to better prioritize ICU beds for the sickest patients. The new process also strengthened collaboration between emergency department and ICU nurses and providers.
The quality improvement project included 275 adult patients admitted directly from the emergency department to the medical ICU. Researchers compared outcomes before and after implementation using medical record data collected during two periods in 2024.
The project was led by pulmonary critical care nurse practitioners Whitney Haley, DNP, APRN, AGACNP-BC, and Rachel Smith, DNP, APRN, AGACNP-BC, CCRN, as part of their Doctor of Nursing Practice program at the University of Alabama at Birmingham School of Nursing.
