Exploring delayed admissions to ICU: A qualitative study of clinician perceptions and observations of the ICU admission process

Objectives: This study aimed to identify the primary barriers to timely ICU admissions from the ED and to assess their impact on patient care. Methods: Between March and June 2023, we conducted a qualitative exploratory study involving direct observations of six ICU admission processes and interviewed fourteen healthcare professionals, including intensivists, ICU and ED nurses, ED consultants, and bed managers. We employed semi-structured interviews and direct observation to analyse the adult ICU admission process, with a specific focus on delays and communication challenges between the ED and ICU. Findings: The analysis revealed several key factors contributing to delays in ICU admissions: (1) ICU capacity constraints, particularly due to bed blocking and staffing shortages during high-acuity periods; (2) administrative delays stemming from pending diagnostic and procedural requirements; and (3) communication breakdowns between the ED and ICU teams, characterised by unclear decision-making protocols. Conclusion: The study highlighted the multifaceted nature of ICU admission delays, which are influenced by limited capacity, staffing challenges, administrative bottlenecks, and communication failures. Clinicians perceived those delays in ICU admissions affected care quality, linking them to negative outcomes such as patient deterioration, prolonged recovery, higher mortality risk, and longer ICU stays. These delays significantly affect the quality of care for critically ill patients and were associated with poorer health outcomes. Implications for clinical practice: To improve the timeliness of ICU admissions from the ED, it is essential to address several key issues: streamlining administrative processes, enhancing interdepartmental communication, and optimising ICU capacity and staffing levels. Hospitals should invest in systems for better bed management, improve coordination between ED and ICU teams, and minimise delays in diagnostic and procedural tasks. By overcoming these barriers, healthcare systems can improve ICU admission efficiency, enhance patient outcomes, and optimise resource utilisation.