title: Transfer Delays From the Neurologic Intensive Care Unit: A Prospective Cohort Study.
abstract: BACKGROUND
  Neurocritical care beds are a scarce, valuable resource. The purpose of this pilot study was to quantify discharge delays from the neurologic intensive care unit (NICU) at a tertiary-care teaching hospital and to examine the impact on overall hospital length of stay (LOS). Secondary goals were to evaluate (1) the effect of NICU delays on patient physical/occupational therapy services and (2) the accuracy of clinician estimates of NICU discharge date and hospital LOS.
  
  
  METHODS
  We conducted a prospective cohort study of consecutive patients discharged over 1 month from NICU. A patient was defined to have experienced a delay when deemed medically ready for NICU discharge (ie, floor transfer) but without actual NICU discharge within 8 hours of the ready time.
  
  
  RESULTS
  Sixty-five patients were discharged from the NICU with an average delay of 25 hours 51 minutes (median 13 hours 3 minutes), of which 60% (39 of 65) of patients were delayed at least 8 hours, while 25% (16 of 65) were delayed at least 48 hours. The primary reason for delay was lack of floor bed availability. NICU admissions that experienced a delay did not have a significantly longer hospital LOS. Clinician estimates on admission of NICU discharge date were within 24 hours for 63% of admissions.
  
  
  CONCLUSIONS
  Discharge delays from the NICU were common but did not significantly increase hospital LOS in this cohort. Delays did not have a significant impact on total physical therapy or occupational therapy duration. Clinician estimates of NICU discharge dates were relatively accurate.
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Morris
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Ayush
authors.initials: A
authors.lastname: Batra
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Biffi
authors.affiliation: Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Cohen
keywords: ICU throughput; discharge; length of stay; neurocritical care; neurohospitalist; transfer delay