SHM Converge Scientific Abstract ePoster Gallery-More Patients Than Beds: Maintaining Quality While Moving Patients

Pdf Summary

This quality improvement project addressed emergency department (ED) boarding of admitted medicine patients at a large urban tertiary hospital. Boarding was recognized as a growing national problem associated with worse patient outcomes, longer delays, and strain on ED resources. The goal was to reduce boarding by transferring patients to the first safe available bed within a four-hospital health system, while maintaining quality of care and avoiding treatment delays.<br /><br />The intervention relied on close collaboration between Emergency Medicine and Hospital Medicine. Key components included: developing shared transfer criteria based on patient acuity and specialty needs; creating a new workflow that allowed patients to be admitted and transferred simultaneously; establishing real-time escalation to leadership when barriers arose; and holding weekly multidisciplinary reviews of delayed or complicated cases to identify problems and implement solutions.<br /><br />A dedicated ED throughput provider screened new medicine admissions and ED boarders. If patients met criteria, the provider discussed transfer with the patient, obtained consent, notified the medical team, and initiated transfer while the patient was still being admitted. The transfer center then located an available bed and the patient was accepted by the receiving hospital’s hospitalist.<br /><br />Results showed a substantial improvement. The number of medicine patients transferred from the ED within the health system increased by 79.6%, rising from 334 patients before the intervention to 600 after it.<br /><br />The authors conclude that inter-hospital transfers can be increased significantly through a coordinated ED-Hospitalist initiative. Success depended on shared leadership, standardized criteria, new workflows, and ongoing review of quality and operational barriers.

Asset Subtitle

Maria Anaizza Reyna

Meta Tag

Author List Andrew S. Dunn, Atara Nissel, Jolion McGreevy, Maria Anaizza Reyna, Preston Yu

Category Innovations

Concept Emergency Department Boarding

Concept Transfer Criteria

Concept Patient Safety

Concept Care Quality

Concept Patient Transfer Workflow

Distinguished Non-Finalist

Presenter Organization Mount Sinai Hospital

Presenting Author Maria Anaizza Reyna

Track Quality Improvement

Keywords

emergency department boarding

hospital medicine

patient transfer

quality improvement

ED throughput

inter-hospital transfer

medicine patients

patient outcomes

multidisciplinary collaboration

bed availability

Emergency Department Boarding

Transfer Criteria

Patient Safety

Care Quality

Patient Transfer Workflow