Barriers and Facilitators to Timely Admission and Transfer of Patients from an Emergency Department to an Intensive Care Unit

Abstract

This ethnographic observational study identified preliminary barriers and facilitators to admission and physical transfer of patients from an emergency department to a medical intensive care unit. Process traces were constructed for eight ICU-bound patients, and aggregated process traces were constructed for communication events and patient handoffs. Barriers to timely admission and transfer include: 1) delays in obtaining proof of severity of illness, 2) difficulty maintaining synchronization across personnel, 3) difficulty uniting disparate sources of information, 4) delays in the readiness of admitting units, 5) needs of other ED patients, and 6) missing information updates. Facilitators include: 1) objective indicators of need for ICU placement, 2) personal communications with ICU personnel, and 3) frequent viewing of information updates. Implications of the findings are discussed.