title: Risk factors for unplanned transfer to the intensive care unit after emergency department admission.
abstract: BACKGROUND
  Unplanned Intensive Care Unit (ICU) admission has been used as a surrogate marker of adverse events, and is used by the Australian Council of Healthcare Accreditation as a reportable quality indicator. If we can identify independent variables predicting deterioration which require ICU transfer within 24h after emergency department (ED) admission, direct ICU admission should be considered. This may improve patient safety and reduce adverse events by appropriate disposition of patients presenting to the ED.
  
  
  OBJECTIVE
  The aim of this study was to identify independent variables predicting deterioration which require ICU transfer within 24h after ED admission.
  
  
  METHODS
  A case control study was performed to examine characteristics of patients who underwent an unplanned transfer to the ICU within 24h after ED admission.
  
  
  RESULTS
  There were significantly more hypercapnia patients in the ICU admission group (n=17) compared to the non-ICU group (n=5) (p=0.028). There were significantly greater rates of tachypnea in septic patients (p=0.022) and low oxygen saturation for patients with pneumonia (p=0.045). The level of documentation of respiratory rate was poor.
  
  
  CONCLUSIONS
  In patients presenting to the ED, hypercapnia was a predictor for deterioration which requires ICU transfer within 24h after ED admission. Additional predicting factors in patients with sepsis or pneumonia were respectively tachypnea and low oxygen saturation. For these patient groups direct ICU admission should be considered to prevent unplanned ICU admission. This data emphasizes the importance of measuring the vital signs, particularly the respiratory rate.
authors.affiliation: Department of Emergency Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands. Electronic address: marleen.boerma@gmail.com.
authors.forename: Lena M
authors.initials: LM
authors.lastname: Boerma
authors.affiliation: Department of Emergency Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
authors.forename: Eef P J
authors.initials: EPJ
authors.lastname: Reijners
authors.affiliation: Department of Emergency Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
authors.forename: Roger A P A
authors.initials: RAPA
authors.lastname: Hessels
authors.affiliation: Department of Emergency Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
authors.forename: Martijn A A
authors.initials: MAA
authors.lastname: V Hooft
mesh_terms: D016022:Case-Control Studies; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000458:organization & administration / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000458:organization & administration; D012307:Risk Factors; D061665:Time-to-Treatment; D055986:Vital Signs
keywords: Adverse events; Deterioration; Disposition of ED patients; Patient safety; Quality indicator; Unexpected ICU admission