(1309) The Impact of Dedicated Just-in-Time ICU Beds for Adult Patients During Rapid Response Activations

Introduction: Critical care outreach teams (CCOTs) and rapid response teams (RRTs) routinely escalate critically ill adult patients to intensive care units (ICUs) from wards and stepdown floors following evaluation and initial management. Historically, the transfer of adult patients to a specialty ICU not in alignment with the patient’s underlying diagnosis or medical problem(s) has been associated with an increase in inpatient mortality.
The purpose of this study is to identify if dedicated “just-in-time” (JIT) medical ICU and surgical ICU beds, which allow for the rapid transfer of an adult patient to an open ICU bed following a CCOT or RRT activation were associated with 1) a change in the incidence in off-service ICU transfers, 2) hospital length of stay (HLOS), and 3) inpatient mortality.

Methods: All CCOT and RRT transfers to 6 specialty ICUs at a large academic center in the Southeastern United States over the 9-month pre-intervention period (January 10, 2022 to October 9, 2022) prior to JIT bed implementation were reviewed and compared to the 9-month post-intervention period (October 10, 2022 to July 10, 2023) following JIT bed implementation. The pre-intervention and post-intervention groups were compared using Chi-square and t-test statistical analysis.

Results: In the pre-intervention group, 130 of 604 patients (21.5%) were transferred to an off-service ICU compared to 100 of 666 patients who were transferred to an off-service ICU in the post-intervention group (p <.05). In the pre-intervention group 165 (27.3%) patients died, and in the post-intervention group, 169 (25.3%) patients died (p=.423). In patients who were alive at the time hospital discharge, HLOS for patients (n=439) in the pre-intervention group was 22.8 days (SD 0.87), and HLOS for patients in the post-intervention group (n=497) was 21.6 days (SD 0.77) (p=0.164).

Conclusions: The creation of JIT medical and surgical ICU beds significantly reduced the incidence of off-service ICU transfers across all ICUs following a CCOT or RRT activation. The utilization of JIT ICU beds was also associated with a trending but not significant reduction in HLOS and in-hospital mortality in all ICUs during the study period.