title: Intra-hospital transfers to a higher level of care: contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS).
abstract: BACKGROUND
  Patients who experience intra-hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single-center studies or studies that employ ICU admissions as the denominator.
  
  
  OBJECTIVE
  To employ automated bed history data to examine outcomes of intra-hospital transfers using all hospital admissions as the denominator.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 19 acute care hospitals.
  
  
  METHODS
  A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008.
  
  
  METHODS
  Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre-existing illness burden; outcomes were: 1) occurrence of intra-hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS).
  
  
  RESULTS
  A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers.
  
  
  CONCLUSIONS
  Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS.
authors.affiliation: Hospital Operations Research, Division of Research, Oakland, California, USA. gabriel.escobar@kp.org
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
authors.forename: John D
authors.initials: JD
authors.lastname: Greene
authors.forename: Marla N
authors.initials: MN
authors.lastname: Gardner
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Marelich
authors.forename: Bryon
authors.initials: B
authors.lastname: Quick
authors.forename: Patricia
authors.initials: P
authors.lastname: Kipnis
mesh_terms: D000208:Acute Disease; D000368:Aged; D002140:California; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors