title: Rate of preventable early unplanned intensive care unit transfer for direct admissions and emergency department admissions.
abstract: OBJECTIVE
  Appropriate patient placement at the time of admission to avoid unplanned transfers to the ICU and codes outside of the ICU is an important safety goal for many institutions. The objective of this study was to determine if the overall rate of unplanned ICU transfers within 12 hours of admission to the inpatient medical/surgical unit was higher for direct admissions compared with emergency department (ED) admissions.
  
  
  METHODS
  This was a retrospective cohort study of all unplanned ICU transfers within 12 hours of admission to an inpatient unit at a tertiary care children's hospital from January 2010 to December 2012. Proportions of preventable unplanned transfers from the ED and from direct admission were calculated and compared.
  
  
  RESULTS
  Over the study period, there were a total of 46,998 admissions; 279 unplanned ICU transfers occurred during the study period of which 101 (36%) were preventable. Preventable unplanned transfers from each portal of entry were calculated and compared with the total number of admissions from those portals. The portals of entry evaluated included admissions from our internal ED versus all outside facility transfers. The rates of early unplanned transfer (per 1000 admissions) by portal of entry were 3.50 for direct admissions and 3.18 for ED. There was no difference between direct admissions and ED admissions resulting in preventable unplanned transfers to the ICU (P=.64).
  
  
  CONCLUSIONS
  Rates of unplanned ICU transfers within 12 hours of admission to an inpatient unit are not higher for direct admissions compared with ED admissions. Further studies are required to determine clinical risk factors associated with unplanned ICU transfer after admission, thus allowing for more accurate initial patient placement.
authors.affiliation: Sections of Hospital Medicine and jennifer.reese@childrenscolorado.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reese
authors.affiliation: Research Informatics, Children's Hospital Colorado, Aurora, Colorado; and.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Deakyne
authors.affiliation: New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
authors.forename: Ashley
authors.initials: A
authors.lastname: Blanchard
authors.affiliation: Emergency Medicine, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado;
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D008297:Male; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement; D012189:Retrospective Studies; D013997:Time Factors; D061665:Time-to-Treatment; D014218:Triage / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D014481:United States
keywords: ICU; direct admission; quality improvement; transfers