title: Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.
abstract: OBJECTIVE
  Numerous factors can cause delays in transfer to an intensive care unit for critically ill emergency department patients. The impact of delays is unknown. We aimed to determine the association between emergency department "boarding" (holding admitted patients in the emergency department pending intensive care unit transfer) and outcomes for critically ill patients.
  
  
  METHODS
  This was a cross-sectional analytical study using the Project IMPACT database (a multicenter U.S. database of intensive care unit patients). Patients admitted from the emergency department to the intensive care unit (2000-2003) were included and divided into two groups: emergency department boarding >or=6 hrs (delayed) vs. emergency department boarding <6 hrs (nondelayed). Demographics, intensive care unit procedures, length of stay, and mortality were analyzed. Groups were compared using chi-square, Mann-Whitney, and unpaired Student's t-tests.
  
  
  METHODS
  Emergency department and intensive care unit.
  
  
  METHODS
  Patients admitted from the emergency department to the intensive care unit (2000-2003).
  
  
  METHODS
  None.
  
  
  RESULTS
  Main outcomes were intensive care unit and hospital survival and intensive care unit and hospital length of stay. During the study period, 50,322 patients were admitted. Both groups (delayed, n = 1,036; nondelayed, n = 49,286) were similar in age, gender, and do-not-resuscitate status, along with Acute Physiology and Chronic Health Evaluation II score in the subgroup for which it was recorded. Among hospital survivors, the median hospital length of stay was 7.0 (delayed) vs. 6.0 days (nondelayed) (p < .001). Intensive care unit mortality was 10.7% (delayed) vs. 8.4% (nondelayed) (p < .01). In-hospital mortality was 17.4% (delayed) vs. 12.9% (nondelayed) (p < .001). In the stepwise logistic model, delayed admission, advancing age, higher Acute Physiology and Chronic Health Evaluation II score, male gender, and diagnostic categories of trauma, intracerebral hemorrhage, and neurologic disease were associated with lower hospital survival (odds ratio for delayed admission, 0.709; 95% confidence interval, 0.561-0.895).
  
  
  CONCLUSIONS
  Critically ill emergency department patients with a >or=6-hr delay in intensive care unit transfer had increased hospital length of stay and higher intensive care unit and hospital mortality. This suggests the need to identify factors associated with delayed transfer as well as specific determinants of adverse outcomes.
authors: Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. dchalfin@applied-decision.com
authors: Donald B
authors: DB
authors: Chalfin
authors: Stephen
authors: S
authors: Trzeciak
authors: Antonios
authors: A
authors: Likourezos
authors: Brigitte M
authors: BM
authors: Baumann
authors: R Phillip
authors: RP
authors: Dellinger
mesh_terms: D018806:APACHE; D000367:Age Factors; D016638:Critical Illness / Q000401:mortality*; D003430:Cross-Sectional Studies; D003710:Demography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010360:Patient Transfer / Q000458:organization & administration*; D012737:Sex Factors