Collaborative ICU Admission Process Cuts Time to Critical Care Involvement by Half

Emergency department boarding of critically ill adults can delay assessment and treatment during the vulnerable transition to intensive care. When intensive care unit beds are unavailable, unclear care ownership and variable admission workflows can further compound delays. These bottlenecks increase the risk of deterioration and inefficient use of critical care resources. To address this challenge, clinicians have developed a collaborative admissions process that expedites critical care involvement for patients awaiting transfer from the emergency department to the intensive care unit.

At Ascension Saint Thomas West Hospital in Nashville, Tennessee, nurse practitioners designed the Medical Intensive Care Unit Admission Management Process (MAMP) as part of the hospital’s move to a closed, intensivist-led model. The intensivist team assumed responsibility for managing care from admission through discharge. MAMP clarifies roles across departments and establishes a consistent pathway for intensive care unit admissions originating in the emergency department.

Under the process, medical intensive care unit and emergency teams collaborate to deliver critical care expertise while patients remain in the emergency department. Consultations and initial assessments occur before bed assignment in the hospital’s 28-bed medical intensive care unit, enabling triage of patients boarding in the emergency department. The approach is intended to prevent delays in definitive management and to standardize escalation during high‑risk transitions.

A quality improvement evaluation included 275 adults admitted directly from the emergency department to the medical intensive care unit. Retrospective records defined a preintervention cohort of 150 patients admitted between February 1 and April 30, 2024. During the intervention period, August 15 to October 20, 2024, 125 patients who met inclusion criteria were managed under MAMP.

After implementation, the mean time to critical care team involvement declined from 113.9 minutes to 56 minutes, a 50.8% reduction. Intensive care unit length of stay rose from a mean of 2.8 days to 3.4 days, while short‑stay admissions of fewer than 24 hours decreased from 23.3% to 19.2%. Together, these shifts signaled an unanticipated benefit: improved allocation of medical intensive care unit resources and prioritization of transfers for the most critically ill patients. The process also fostered ongoing collaboration between emergency and intensive care nursing staff and providers, improving the patient care experience.

Findings and process details were published in AACN Advanced Critical Care.on June 15, The project was led by pulmonary critical care nurse practitioners at Ascension Saint Thomas West Hospital as part of the Doctor of Nursing Practice program at the University of Alabama at Birmingham School of Nursing.

“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. In essence, it brings MICU-level expertise to the patient during a high-risk transition period,” said Whitney Haley, DNP, APRN, AGACNP-BC, pulmonary critical care nurse practitioner at Ascension Saint Thomas West Hospital.

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Ascension Saint Thomas West Hospital