Reducing Emergency Department to Medical ICU Boarding Times: Implementing a Standardized Escalation Protocol at a Large Medical Center Hospital

Authors

• Taylor A. Robbins-Ethridge, University of Texas Health Science Center at HoustonFollow

Author Biographical Info

Taylor Robbins-Ethridge, BSN, RN, CEN, TCRN, is an Emergency Department Registered Nurse at a large Level I trauma center in Texas. She has extensive experience in high-acuity emergency and critical care environments, with leadership roles including Charge Nurse, Trauma Team Lead, and Medicine Team Lead. She is currently pursuing a Doctor of Nursing Practice (DNP) – Family Nurse Practitioner degree at the Cizik School of Nursing at UTHealth Houston. Her scholarly and clinical interests focus on emergency department throughput, critical care transitions, and quality improvement initiatives aimed at optimizing patient flow and outcomes.

Date of Doctor of Nursing Practice Project Completion

Fall 11-30-2025

Faculty Advisor

Dr. Rashmi Momin

Abstract

Prolonged emergency department (ED) boarding of critically ill patients awaiting transfer to the medical intensive care unit (MICU) delays access to definitive care and is associated with increased mortality and longer hospital stays. This quality improvement project aimed to reduce ED boarding times for MICU patients by implementing the Bed Ready in 30: Just Say Yes escalation protocol. The Plan–Do–Study–Act (PDSA) framework guided the implementation of a structured escalation process to standardize nurse-to-nurse communication once a MICU bed was marked as ready in the electronic health record. A pre–post observational study was used to evaluate the intervention using electronic health record timestamp data. Following implementation, the median ED boarding time decreased from 72 minutes to 49 minutes. Staff reported improved communication, clearer expectations, and more efficient coordination during ED-to-MICU transfers. Factors such as room readiness, equipment availability, and unit acuity continued to influence transfer times. These findings suggest that structured escalation pathways can improve patient flow and reduce delays in critical care transitions. This intervention is practical, sustainable, and may be replicated in other high-acuity healthcare environments.

Keywords

emergency department boarding, ICU transfer, medical ICU, patient flow, nurse handoff, quality improvement, throughput, critical care transitions

Recommended Citation

Taylor A. Robbins-Ethridge, "Reducing Emergency Department to Medical ICU Boarding Times: Implementing a Standardized Escalation Protocol at a Large Medical Center Hospital" (2025). Doctor of Nursing Practice Final Project Abstract. 190.
https://digitalcommons.library.tmc.edu/dnp_abstract/190