title: Delay of transfer from the intensive care unit: a prospective observational study of incidence, causes, and financial impact.
abstract: BACKGROUND
  A paucity of literature exists regarding delays in transfer out of the intensive care unit. We sought to analyze the incidence, causes, and costs of delayed transfer from a surgical intensive care unit (SICU).
  
  
  METHODS
  An IRB-approved prospective observational study was conducted from January 24, 2010, to July 31, 2010, of all 731 patients transferred from a 20-bed SICU at a large tertiary-care academic medical center. Data were collected on patients who were medically ready for transfer to the floor who remained in the SICU for at least 1 extra day. Reasons for delay were examined, and extra costs associated were estimated.
  
  
  RESULTS
  Transfer to the floor was delayed in 22% (n = 160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean, 1.5 days; median, 2 days). The extra costs associated with delays were estimated to be $581,790 during the study period, or $21,547 per week. The most common reasons for delay in transfer were lack of available surgical-floor bed (71% (114 of 160)), lack of room appropriate for infectious contact precautions (18% (28 of 160)), change of primary service (Surgery to Medicine) (7% (11 of 160)), and lack of available patient attendant ("sitter" for mildly delirious patients) (3% (five of 160)). A positive association was found between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman rho = 0.27; P < 0.0001).
  
  
  CONCLUSIONS
  Delay in transfer from the SICU is common and costly. The most common reason for delay is insufficient availability of surgical-floor beds. Delay in transfer is associated with high hospital census. Further study of this problem is necessary.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Ulrich H
authors.initials: UH
authors.lastname: Schmidt
authors.forename: Edward A
authors.initials: EA
authors.lastname: Bittner
authors.forename: Benjamin
authors.initials: B
authors.lastname: Christensen
authors.forename: Retsef
authors.initials: R
authors.lastname: Levi
authors.forename: Richard M
authors.initials: RM
authors.lastname: Pino
mesh_terms: D003365:Costs and Cost Analysis; D017598:Efficiency, Organizational; D006742:Hospital Bed Capacity; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008404:Massachusetts; D010360:Patient Transfer / Q000191:economics*; D011446:Prospective Studies; D013997:Time Factors