Collaborative Process Clarifies ICU Admissions from ED

ALISO VIEJO, Calif. – July 15, 2026 – From the emergency department (ED) to the intensive care unit (ICU), a clear and collaborative admissions process at a Tennessee hospital decreased the time in half for newly admitted critically ill patients to receive specialized care, even as they waited in the ED for an ICU bed to be available.

Nurse practitioners at Ascension Saint Thomas West Hospital, Nashville, Tennessee, developed a multipronged interdepartmental care model that prioritized rapid assessment and treatment of patients admitted to the 28-bed medical intensive care unit (MICU) from the ED and awaiting an assigned bed.

As part of the hospital’s transition to a closed ICU model, an intensivist-led team began to fully manage the care for critically ill patients from admission to discharge, instead of being called in for a consulting role when requested by an attending hospitalist. The shift in clinician roles required changing the long-standing admissions process and provided an opportunity to clarify responsibilities and resolve variations between departments and among clinicians.

“Critical Care Consultations for Patients Boarding in the Emergency Department” details development and implementation of the new MICU Admission Management Process (MAMP) for patients admitted to the MICU directly from the ED. The article is published in the Summer 2026 issue of AACN Advanced Critical Care.

Co-authors Whitney Haley, DNP, APRN, AGACNP-BC, and Rachel Smith, DNP, APRN, AGACNP-BC, CCRN, are pulmonary critical care nurse practitioners at the hospital. They led the quality improvement project as part of the Doctor of Nursing Practice degree program at University of Alabama at Birmingham School of Nursing and were mentored by Assistant Professor Dana Mitchell, DNP, ACNP-BC, CHFN.

“The updated admissions process alleviates any uncertainty about which medical team is managing a patient’s care and ensures that definitive care and assessment by the critical care team aren’t hampered by delays in transfer to the MICU,” Haley said. “In essence, it brings MICU-level expertise to the patient during a high-risk transition period.”

As part of the new admissions process, the MICU and ED teams collaborated to ensure that patients who were not promptly transferred to the MICU did not have delays in care. Critical care consultations and initial assessments occurred prior to the patient’s arrival in the MICU and enabled triage of patients being boarded in the ED.

After the MAMP protocol was implemented, patients spent less time waiting for critical care team involvement, from a preintervention mean of 113.9 minutes to a postintervention mean of 56 minutes (a 50.8% reduction).

The study also examined ICU length of stay and the number of patients who spent fewer than 24 hours in the MICU after being admitted from the ED. Although ICU length of stay increased (mean of 2.8 days prior to implementation to 3.4 days afterward), short-stay admissions decreased slightly from 23.3% before to 19.2% after implementation. The combination signaled an unanticipated benefit of the MAMP protocol — by providing critical care expertise while patients were in the ED, the team was able to improve allocation of MICU resources and prioritize transfer for the most critically ill patients.

MAMP also led to ongoing interactions and greater collaboration between ED and ICU nursing staff and providers, which improved the patient care experience.

The study involved 275 adult patients who met established inclusion criteria and were admitted directly from the ED to the MICU. Retrospective data from medical records were used to establish the preintervention sample, with 150 patients included who were admitted between Feb. 1 and April 30, 2024. During the intervention period, from Aug. 15 to Oct. 20, 2024, 125 patients were admitted to the MICU from the ED who met the inclusion criteria.

AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue also includes a topic-based symposium, feature articles and columns of interest to critical care and progressive care clinicians.

Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org.

About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses (AACN), the journal has a circulation of more than 136,000 and can be accessed at http://acc.aacnjournals.org.

About the American Association of Critical-Care Nurses: For more than 55 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 136,000 members and about 170 chapters in the United States.

American Association of Critical-Care Nurses
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