Preventing unnecessary interhospital transfers to urban medical centers

Context: Intensive care interhospital transfers result in longer hospitalization and greater patient mortality and morbidity. Preventing transfers require commitment from providers at all stages of patient's clinical care to keep care local and maximize limited resources. Purpose: Describe how changes in hospital workflow and inter-departmental communication resulted in a decrease in transfers due to lack of intensive care beds. Methods: Implemented a workflow involving the Intensive Care Unit (ICU), Emergency Department, and hospitalist to anticipate and address shortages in ICU beds in real time to accommodate for new critical care admissions and free up floor beds to allow for timely ICU downgrades. Providers from each department change on a regular basis, but communication occurs across all departments cotinuously to allow all components to work seamlessly. Findings: Implementation of workflow over 2 years resulted in decrease in interhospital transfers due to lack of ICU beds from 11.0 transfers per month to 5.2 (P < 0.01). Hospital CMI went from 1.02 to 1.29 as an indication of greater retention of critically ill patients. Conclusion: A team-approach to managing critically ill patients can lead to a substantial reduction in interhospital transfers, increase case mix index, and improve interdisciplinary communication and continuity of care.