Implementation of the admission transfer unit to reduce emergency department boarding: A quality improvement initiative

Emergency Department (ED) boarding crowds the emergency department, strains resources, leads to higher hospital costs, and is associated with increased morbidity/mortality, a negative patient experience, and patient adverse events. The time Ontario patients wait in emergency departments for inpatient beds continues to rise, with the average time admitted patients spend in the ED increasing between 2015 and 2019 from 13.8 hours to 16.2 hours. As reported in this quality improvement initiative, one potential solution is to repurpose short-stay medical assessment units for complex admitted medicine patients using an objective patient selection tool. Objectively selecting admitted ED patients with the highest risk for adverse events and prioritizing them to move to a transitional unit advances safe quality patient care and decreases Time-to-Inpatient Bed (TIB). Results from this quality improvement initiative include reducing the organization’s TIB by 13 hours.