title: Interhospital transfers of the critically ill: Time spent at referring institutions influences survival.
abstract: To determine if the length of stay at a referring institution intensive care unit (ICU) before transfer to a tertiary/quaternary care facility is a risk factor for mortality.
  
  
  
  We performed a retrospective chart review of patients transferred to our ICU from referring institution ICUs over a 3-year period. Logistical regression analysis was performed to determine which factors were independently associated with increased mortality. The primary outcomes were ICU and hospital mortality.
  
  
  
  A total of 1248 patients were included in our study. Length of stay at the referring institution was an independent risk factor for both ICU and hospital mortality (P<.0001), with increasing lengths of stay correlating with increased mortality. Each additional day at the referring institution was associated with a 1.04 increase in likelihood of ICU mortality (95% confidence interval, 1.02-1.06; P =0.001) and a 1.029 (95% confidence interval, 1.01-1.05; P .005) increase in likelihood of hospital mortality.
  
  
  
  Length of stay at the referring institution before transfer is a risk factor for worse outcomes, with longer stays associated with increased likelihood of mortality. Further studies delineating which factors most affect length of stay at referring institutions, though a difficult task, should be pursued.
authors.affiliation: Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA. Electronic address: hananet@ccf.org.
authors.forename: Tarik
authors.initials: T
authors.lastname: Hanane
authors.affiliation: Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiles
authors.affiliation: Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Mourad H
authors.initials: MH
authors.lastname: Senussi
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Xiaozhen
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Wang
authors.affiliation: Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: R Duncan
authors.initials: RD
authors.lastname: Hite
authors.affiliation: Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Guzman
mesh_terms: D018806:APACHE; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009820:Ohio; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D012017:Referral and Consultation; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Interhospital transfer