Introduction: ED boarding and overcrowding increase ED LOS for critical care patients. ED-based ICUs are hypothesized to improve patient outcomes, reduce ED LOS, and improve capacity by enhancing the care of critically ill patients in the ED. The FLEX ICU is a novel ICU with the stated mission of improving the efficiency of care for critically ill patients. Embedded within the FLEX-ICU is the Donor Care Unit (DCU) for the Network for Hope- a unique model linking the care of regional brain dead donors with critical care and organ resuscitation. Methods: Operational quality data were collected between Oct 1, 2024 and June 30, 2025. System-level analytics (Tableau) were used to calculate observed vs expected ICU LOS, ED LOS, system critical care capacity, and financial impact for LOS shift. Organs transplanted per donor in the Donor Care Unit were compared to organ procurement historical performance metrics. Results: 941 patients were admitted during the initial time period. 648 (68. 9%) from the ED, 176 (18. 7%) were from external transfers (18. 7%), 83 (8. 8%) were internal transfers, 21 (2. 9%) admissions from procedural areas, and 7 (0. 7%) were direct admissions. 272 (28. 9%) were discharged directly home from the FLEX-ICU, 81 (8. 6%) were transferred to another ICU, and 512 (54. 4%) were discharged to the floor. There was no identified reduction in ED LOS. Observed vs expected geometric mean LOS (O/E) was 0. 85 for all patients admitted to the FLEX-ICU. Financial impact modeling of a 15% reduction in O/E LOS yields a system savings of 3. 69M per 1000 patients. Of the 19 organ procurements, organs transplanted per donor increased 90. 1% (4. 15 vs. 2. 17) in the donors cared for in the FLEX ICU/DCU compared to the surrounding donor service area. Conclusions: The FLEX ICU at the University of Cincinnati is a novel concept ICU which improves efficiency of critical care. Our initial data from the FLEX ICU demonstrate reductions in LOS for FLEX-ICU patients and significant financial impact attributable to improved efficiency. Brain dead organ donors managed in the FLEX ICU had a significant increase in organs transplanted per donor, a unique outcome with far reaching potential impact for organ donation. The FLEX-ICU’s novel operational mission is worthy of continued study and likely scaling to similar institutions.
Bennett-Hardy et al. (Sun,) studied this question.