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

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.