title: Under-triage as a significant factor affecting transfer time between the emergency department and the intensive care unit.
abstract: BACKGROUND
  The purpose of the study was to identify factors that affect transfer times between the emergency department and the intensive care unit (ICU) in a community hospital. Patients who are transferred from the emergency department to the ICU are usually in critical condition and in need of prompt treatment by qualified personnel. As a result of delayed transfers, a patient may experience complications, such as increased mortality rates and longer hospital stays.
  
  
  METHODS
  A quantitative descriptive correlational design was used in this study. Data were collected from the charts of 75 patients who were transferred from the emergency department to the ICU of a 142-bed community hospital in the eastern United States. "Delayed patients" were identified as those who were transferred after more than 4 hours.
  
  
  RESULTS
  Forty-four patients (58.7%) spent more than 4 hours in the emergency department. Nineteen out of 25 patients (76%) with an Emergency Severity Index designation of 3 were identified as delayed. Delayed status and an Emergency Severity Index designation of 3 showed a significant correlation (r = -.339, P = .004). Eleven patients (64.7%) diagnosed with sepsis were delayed, compared with 6 who were not delayed. A total of 70.4% of female patients were delayed, compared with 52.1% of male patients.
  
  
  CONCLUSIONS
  This study provides a more comprehensive view of the factors involved in delayed patient transfer and provides data needed for effective interventions to be developed. The results suggest significant problems with the under-triage of critically ill patients, specifically patients with sepsis. Future research should include a larger group of subjects and a multifactorial analysis.
authors.affiliation: Hadley at Elaine Rehabilitation Center, Hadley, MA, USA.
authors.forename: Irina
authors.initials: I
authors.lastname: Yurkova
authors.forename: Lisa
authors.initials: L
authors.lastname: Wolf
mesh_terms: D000367:Age Factors; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000592:standards / Q000639:trends; D005069:Evaluation Studies as Topic; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D020380:Needs Assessment; D010360:Patient Transfer / Q000592:standards / Q000639:trends*; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000628:therapy*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage; D014481:United States