Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system.
BACKGROUND
Patients with intensive care unit (ICU) transfers from hospital wards have higher mortality than those directly admitted from the emergency department.


OBJECTIVE
To describe the association between the timing of unplanned ICU transfers and hospital outcomes.


METHODS
Evaluation of 6369 early (within 24 hours of hospital admission) unplanned ICU transfer cases and matched directly admitted ICU controls from an integrated healthcare system. Cohorts were matched by predicted mortality, age, gender, diagnosis, and admission characteristics. Hospital mortality of cases and controls were compared based on elapsed time and diagnosis.


RESULTS
More than 5% of patients admitted through the emergency department experienced an unplanned ICU transfer; the incidence and rates of transfers were highest within the first 24 hours of hospitalization. Multivariable matching produced 5839 (92%) case-control pairs. Median length of stay was higher among cases (5.0 days) than controls (4.1 days, P < 0.01); mortality was also higher among cases (11.6%) than controls (8.5%, P < 0.01). Patients with early unplanned transfers were at an increased risk of death (odds ratio, 1.44; 95% confidence interval, 1.26-1.64; P < 0.01); an increased risk of death was observed even among patients transferred within 8 hours of hospitalization. Hospital mortality differed based on admitting diagnosis categories. While it was higher among cases admitted for respiratory infections and gastrointestinal bleeding, it was not different for those with acute myocardial infarction, sepsis, and stroke.


CONCLUSIONS
Early unplanned ICU transfers-even within 8 hours of hospitalization-are associated with increased mortality; outcomes vary by elapsed time to transfer and admitting diagnosis.
Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA. vinliu@stanford.edu
Vincent
V
Liu
Patricia
P
Kipnis
Norman W
NW
Rizk
Gabriel J
GJ
Escobar
D000368:Aged; D000369:Aged, 80 and over; D002140:California; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors