What question did this study set out to answer?

This initiative aims to improve ICU throughput by reducing transfer delays and length of stay through timely transfer orders.

March 26, 2026

737: Earlier Transfer Orders Improve Icu Throughput: A Quality Improvement Initiative

Key Points

This initiative aims to improve ICU throughput by reducing transfer delays and length of stay through timely transfer orders.
Retrospective data collection from electronic health records and outcome databases.
Comparison of transfer orders placed before and after 10 a.m. in ICU patients.
Implementation of a structured intervention including checklists, education, and reminders.
Analysis of ICU transfer delay, length of stay, and hospital length of stay.
Intervention group had a significantly reduced ICU transfer delay (13.7 hrs vs. 15.2 hrs, p = 0.005).
ICU length of stay decreased (3.2 days vs. 3.9 days, p = 0.0001).
Hospital length of stay improved (9.6 days vs. 10.4 days, p = 0.02).
No difference in patient safety measures or re-admissions within 24 hours.

Abstract

Introduction: Delays in ICU transfer processes can prolong ICU and hospital length of stay (LOS), negatively impacting throughput and resource utilization. This quality improvement (QI) initiative sought to reduce ICU transfer delays and LOS by implementing a structured intervention to place transfer orders before 10 a.m. Methods: All data were retrospectively collected from electronic health record (EPIC) and acute physiologic and chronic health evaluation (APACHE) Outcome database on patients admitted to ICU (26 Neuro-trauma ICU beds, and 24 Med-Surg ICU beds). This QI project compared adult ICU patients with transfer orders placed before 10 a.m. (n=1793) versus after 10 a.m. (n=1151). Exclusions included patients requiring tracheostomies or those who self-extubated. The intervention involved: (1) incorporating transfer readiness into a daily bedside checklist, (2) targeted education on safe and efficient transfers, (3) weekly email reminders to ICU attendings and fellows, and (4) sharing weekly performance data (ICU- and provider-specific). Outcomes included ICU transfer delay (defined as time from transfer order to physical ICU departure), ICU LOS, and hospital LOS. Results: The intervention was implemented in January 2024. Baseline characteristics were similar between groups: mean age was 62 ± 18 (before 10 a.m.) vs. 61 ± 19 years (after 10 a.m.), p = 0.2; male gender was 49% in both groups, p = 1.0; APACHE IV score was 48 ± 22 in both, p = 1.0; and APS (acute physiologic score) was 36 ± 19 (before) vs. 36 ± 18 (after), p = 1.0. There were similar proportion of patients re-admitted to ICU within 24 hours of transfer (1 % vs 2.5 %, p = 0.6) respectively. The intervention group (before 10 a.m.) had significantly improved outcomes: ICU transfer delay: 13.7 ± 13.6 hrs vs. 15.2 ± 15.0 hrs (p = 0.005), ICU LOS: 3.2 ± 3.1 days vs. 3.9 ± 4.5 days (p = 0.0001), and hospital LOS: 9.6 ± 8.5 days vs. 10.4 ± 9.0 days (p = 0.02). Conclusions: A targeted intervention to improve the timing of ICU transfer orders led to reduced transfer delays, ICU LOS, and hospital LOS without compromising patient safety. Early identification of transfer readiness during rounds and consistent team engagement were key to success. This low-cost, replicable intervention may help ICUs enhance throughput and optimize resource use.

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