title: Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity.
abstract: OBJECTIVE
  To examine if delayed transfer to the intensive care unit (ICU) after physiologic deterioration is associated with increased morbidity and mortality.
  
  
  METHODS
  Inception cohort.
  
  
  METHODS
  Community hospital in Ogden, Utah.
  
  
  METHODS
  Ninety-one consecutive inpatients with noncardiac diagnoses at the time of emergent transfer to the ICU. We determined the time when each patient first met any of 11 pre-specified physiologic criteria. We classified patients as "slow transfer" when patients met a physiologic criterion 4 or more hours before transfer to the ICU. Patients were followed until discharge.
  
  
  METHODS
  None.
  
  
  METHODS
  In-hospital mortality, functional status at hospital discharge, hospital resources.
  
  
  RESULTS
  At the time when the first physiologic criterion was met on the ward, slow- and rapid-transfer patients were similar in terms of age, gender, diagnosis, number of days in hospital prior to ICU transfer, prehospital functional status, and APACHE II scores. By the time slow-transfer patients were admitted to the ICU, they had significantly higher APACHE II scores (21.7 vs 16.2; P =.002) and were more likely to die in-hospital (41% vs 11%; relative risk [RR], 3.5; 95% confidence interval [95% CI], 1.4 to 9.5). Slow-transfer patients were less likely to have had their physician notified of deterioration within 2 hours of meeting physiologic criteria (59% vs 31%; P =.001) and less likely to have had a bedside physician evaluation within the first 3 hours after meeting criteria (23% vs 83%; P =.001).
  
  
  CONCLUSIONS
  Slow transfer to the ICU of physiologically defined high-risk hospitalized patients was associated with increased risk of death. Slow response to physiologic deterioration may explain these findings.
authors.affiliation: University of Vermont College of Medicine, Division of Pulmonary and Critical Care, Burlington, Vt, USA. michael.young@vtmednet.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Young
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Gooder
authors.forename: Karen
authors.initials: K
authors.lastname: McBride
authors.forename: Brent
authors.initials: B
authors.lastname: James
authors.forename: Elliott S
authors.initials: ES
authors.lastname: Fisher
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data*; D008297:Male; D010360:Patient Transfer; D013997:Time Factors; D014589:Utah