title: Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center.
abstract: OBJECTIVE
  Mortality and length of stay are two outcome variables commonly used as benchmarks in rating the performance of medical centers. Acceptance of transfer patients has been shown to affect both outcomes and the costs of health care. Our objective was to compare observed and predicted lengths of stay, observed and predicted mortality, and resource consumption between patients directly admitted and those transferred to the intensive care unit (ICU) of a large academic medical center.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Mixed medical/surgical ICU of a university hospital.
  
  
  METHODS
  A total of 4,569 consecutive patients admitted to a tertiary care ICU from April 1, 1997, to March 30, 2000.
  
  
  METHODS
  None.
  
  
  METHODS
  Acute Physiology and Chronic Health Evaluation (APACHE) III score, actual and predicted ICU and hospital lengths of stay, actual and predicted ICU and hospital mortality, and costs per admission.
  
  
  RESULTS
  Crude comparison of directly admitted and transfer patients revealed that transfer patients had significantly higher APACHE III scores (mean, 60.5 vs. 49.7, p < .001), ICU mortality (14% vs. 8%, p < .001), and hospital mortality (22% vs. 14%, p < .001). Transfer patients also had longer ICU lengths of stay (mean, 6.0 vs. 3.8 days, p < .001) and hospital lengths of stay (mean, 20 vs. 15.9 days, p < .001). Stratified by disease severity using the APACHE III model, there was no difference in either ICU or hospital mortality between the two populations. However, in the transfer group with the lowest predicted mortality of 0-20%, ICU and hospital lengths of stay were significantly higher. In crude cost analysis, transfer patients' costs were $9,600 higher per ICU admission compared with nontransfer patients (95% confidence interval, $6,000-$13,400). Risk stratification revealed that the higher per-patient cost was entirely confined to the transfer patients with the lowest predicted mortality.
  
  
  CONCLUSIONS
  Patients transferred to a tertiary care ICU are generally more severely ill and consume more resources. However, they have similar adjusted mortality outcomes when compared with directly admitted patients. The difference in resource consumption is mainly attributable to the group of patients in the lowest predicted risk bracket.
authors: Division of Allergy and Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. exg@medicine.wisc.edu
authors: Ellie
authors: E
authors: Golestanian
authors: Jesse E
authors: JE
authors: Scruggs
authors: Ronald E
authors: RE
authors: Gangnon
authors: Rosa P
authors: RP
authors: Mak
authors: Kenneth E
authors: KE
authors: Wood
mesh_terms: D018806:APACHE; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010360:Patient Transfer / Q000458:organization & administration*