Napoleon famously said, “Geography is destiny.” Is this true in your hospital? Some days, it seems that your location in the hospital determines the level of care delivered. Does your emergency department provide the same excellent care as your intensive care unit?
Patients in the ICU get good nursing ratios, high-end monitors, and teams of people looking after them. We work equally hard in the ED, but sometimes it appears that the level of care we achieve is not quite as polished.
Several barriers exist for delivering high-level care in the ED. Staff may not have the same degree of knowledge and skill of the latest evidence or procedures. EDs also typically lack optimal resources, including health care workers (fewer pharmacists, RTs, and nurses), and gear (fewer gadgets and less monitoring capability). But most importantly, the primary resource crunch in the ED is time. Patients stream through the doors, and emergency physicians and nurses often lack the time to optimize their critically ill patients fully.
Despite these barriers, delivering excellent critical care in the ED is an important goal for patient outcomes. Given an understanding of the challenges, here is a Top 10 list of ideas for improving ICU care in the ED for critically ill patients. My goal is to inspire you to pick one or two of these ideas and to start incorporating them into your hospital. Some of these are long-term planning ideas that may require a five- or 10-year plan, but some of them you can implement tomorrow. I start with those that are most difficult to implement and work toward the easiest.