A Call in Time Saves Nine: Impact of Automating Rapid Assessment Team Notification on ICU Transfers

Introduction: Patients requiring critical care service consultation often deteriorate rapidly and may require immediate physician and nursing interventions. Delayed or inconsistent communication may lead to missed opportunities for timely care. Leveraging existing workflows to automate notification of multidisciplinary critical care teams may decrease response time and potentially impact rates of ICU transfer. This study evaluated the effect of implementing automated Rapid Assessment Team (RAT) notification at the time of a medical intensive care unit (MICU) consult on rates of ICU transfer.


Methods: To estimate the effect of automated RAT notification on rates of ICU transfer, an interrupted time series (ITS) analysis was performed. Patients >11 years of age hospitalized at Parkland Hospital September 1, 2024 – June 30, 2025, were included. Hospitalizations beginning prior to February 1, 2025, were defined as pre-implementation. The primary outcome was ICU transfer, defined as admission to an ICU from a non-ICU inpatient ward. Rates of ICU transfers were calculated per 1,000 patient-days to normalize fluctuating hospital volumes. To quantify the effect of automated RAT notification of MICU consults, Poisson regression ITS models were constructed using monthly ICU transfer rates per 1,000 patient-days, and both step and post-intervention slope changes were estimated.


Results: In the overall cohort (n=33,819), rates of ICU transfer per 1,000 patient-days decreased following implementation of automated RAT notification of MICU consults. Automated RAT notification was associated with a 15% per month decrease in ICU transfer rates in both unadjusted (IRR 0.85 [95% CI 0.76, 0.95], p-value=0.006) and adjusted analyses (IRR 0.86 [95% CI 0.76, 0.96], p-value=0.007). No significant step change in ICU transfers was observed at the time of implementation.


Conclusions: Automated RAT notification with MICU consults was associated with a decrease in ICU transfers. This may be due to earlier involvement by critical care nurses, facilitating more timely assessments and interventions for clinically deteriorating patients. These findings support the role of early critical care response and intervention in expediting care and preventing avoidable ICU transfers.