From ED to ICU: Is the Nurse Ready?

Abstract

The American College of Emergency Physicians (ACEP) (2021), the Emergency Nurses Association (ENA) (2021), and the Society of Critical Care Medicine (Nates et al., 2016) define a patient’s readiness for transfer from the emergency department (ED) to the intensive care unit (ICU) “as soon as the disposition decision by the treating emergency physician has been made.” This bed assignment process can occur so rapidly as to impede the completion of emergency nursing care. Following a physician’s decision to admit a patient to an ICU, the intrafacility transfer of critically ill patients is a nurse led process, as evidenced by best practice, Agency for Healthcare Research and Quality (AHRQ) and Banner Health policy, in both completing a nurse-to-nurse patient report as well as physically accompanying the patient from the ED to the ICU. Quality improvement (QI) projects to speed up ED-to-ICU transfer and decrease ED length-of-stay (LOS) have demonstrated worse clinical outcomes (Stankiewicz et al., 2019). Patients are too hastily downgraded from the ICU to make room, and patients leave the ED incompletely resuscitated (Bhakta et al., 2013). Additional research identified near simultaneous ICU admissions to endanger the admits as provider attention is distracted (Kashiouris et al., 2019). Surveying the nursing definition of readiness in the intrafacility transfer process is unexplored by the current literature, however prior studies have shown bedside nursing judgement to be predictive of clinical indicators of readiness (e.g., ventilator weaning), thus nursing gestalt in this domain is deserving of exploration (Hirzallah et al., 2019).