title: Location of patients before transfer to a tertiary care intensive care unit: impact on outcome.
abstract: OBJECTIVE
  To evaluate the impact of the source of patients transferred to a tertiary care intensive care unit (ICU) (referring hospital ICU vs referring hospital emergency department [ED]) on outcomes of transferred patients.
  
  
  METHODS
  We performed a retrospective review of data contained in the Project Impact database of a medical-surgical ICU at a university hospital.
  
  
  METHODS
  A total of 503 patients transferred from local community hospitals, 283 from EDs and 220 from ICUs, were identified and included. In addition to comparing all ED transfers with all ICU transfers, comparisons between the 2 populations were made for the subgroups of patients with intracranial hemorrhage (group 1), nonhemorrhagic stroke (group 2), and all other patients (group 3).
  
  
  RESULTS
  Patients were evaluated for a variety of outcome parameters, including mortality and ICU and hospital length of stay (LOS) according to their location at the referring hospital at the time of transfer: ICU (ICUtx) or ED (EDtx). Mortality was significantly lower among EDtx in all transferred patients as well as in groups 2 and 3 with no difference in mortality identified in group 1. Intensive care unit LOS was shorter for EDtx and the 3 groups, and hospital LOS was shorter among all EDtx and those in group 3. Group 3 EDtx also had lower than predicted mortality.
  
  
  CONCLUSIONS
  Transfer of patients to a tertiary care ICU from the ED of a referring hospital is associated with significantly better outcomes than transfers from referring hospital ICUs.
authors.affiliation: Critical Care Medicine, Cooper University Hospital, Camden, NJ 08103, USA. gerber-dave@cooperhealth.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Gerber
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.forename: Imtiaz
authors.initials: I
authors.lastname: Ahmed
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Joseph
authors.initials: J
authors.lastname: Parrillo
mesh_terms: D018806:APACHE; D000328:Adult; D003422:Critical Care / Q000458:organization & administration; D004636:Emergency Service, Hospital; D006301:Health Services Needs and Demand; D017052:Hospital Mortality; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D009515:New Jersey / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010360:Patient Transfer / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D014218:Triage