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Appropriate Admissions to the Appropriate Unit: A Decision Tree Approach

Patient Care Services, Critical Care, jmatukaitis{at}christianacare.org

Paula Stillman, MD, MBA

Elizabeth Wykpisz, RN, MSN, MBA, CNAA, BC

Edward Ewen, MD

Christiana Care Health System, Newark, Delaware

An intermediate care decision tree tool was developed to meet the demand for intermediate care beds. Concurrently, a charging process was developed to support the acuity adaptable model of care, allowing the patient to remain in the same bed from admission to discharge, regardless of level of care required, adjusting nurse-to-patient ratios as acuity changes. Since beginning this pilot, 96% to 100% of the patients admitted to intermediate care from the emergency department met the criteria. Wait time from request to admission was reduced from 5.5 hours to 2.5 hours. A reduction in nursing costs was noted. The average number of patients waiting daily in the emergency department for an intermediate care bed has been reduced by approximately 80%. A significant difference in length of stay was not noted.

Key Words: intermediate care • admissions • decision tree • acuity adaptable • intensive care

American Journal of Medical Quality, Vol. 20, No. 2, 90-97 (2005)
DOI: 10.1177/1062860604274382


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