First, we established a joint Critical Care Operations Committee, improving communication and partnership between the critical care, emergency, and hospital medicine service lines, nursing and respiratory care teams, clinical pharmacy and case management and offering a clear avenue for collaboration between patient care departments.

SCP created and implemented standardized Spontaneous Awakening and Breathing Protocols on all mechanically ventilated patients, including education and bedside training of ICU nursing and respiratory care teams. In partnership with the hospital, they also implemented formalized daily Interdisciplinary Rounds to address daily goals of care and ensure best practices were in place. The decision to extubate a patient was determined during this time.

Through improved collaboration between the ED clinicians and nursing teams, all ICU admission requests were seen within 30 minutes of notification, allowing for assessment of ICU admission appropriateness and ensuring the ED team was supported with clinical guidance and ICU-specific order set implementation.