Abstract
Hypothesis
Unplanned intensive care unit (ICU) transfer (UIT) within 48 hours of emergency department
(ED) admission increases morbidity and mortality. We hypothesized that a majority
of UITs do not have critical interventions (CrIs) and that CrI is associated with
worse outcomes.
Objective
The objective of the study is to characterize all UITs (including patients who died
before ICU transfer), the proportion with CrI, and the effect of having CrI on mortality.
Design
This is a single-center, retrospective cohort study of UITs within 48 hours from 2008
to 2013 at an urban academic medical center and included patients 18 years or older
without advanced directives (ADs). Critical intervention was defined by modified Delphi
process. Data included demographics, comorbidities, reasons for UIT, length of stay,
CrIs, and mortality. We calculated descriptive statistics with 95% confidence intervals
(CIs).
Results
A total of 837 (0.76%) of 108 732 floor admissions from the ED had a UIT within 48
hours; 86 admitted patients died before ICU. We excluded 23 ADs, 117 postoperative
transfers, 177 planned ICU transfers, and 4 with missing data. Of the 516 remaining,
65% (95% CI, 61%-69%) received a CrI. Unplanned ICU transfer reasons are as follows:
33 medical errors, 90 disease processes not present on arrival, and 393 clinical deteriorations.
Mortality was 10.5% (95% CI, 8%-14%), and mean length of stay was 258 hours (95% CI,
233-283) for those with CrI, whereas the mortality was 2.8% (95% CI, 1%-6%) and mean
length of stay was 177 hours (95% CI, 157-197) for those without CrI.
Conclusions
Unplanned ICU transfer is rare, and only 65% had a CrI. Those with CrI had increased
morbidity and mortality.
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Article Info
Publication History
Published online: May 11, 2016
Accepted:
May 7,
2016
Received in revised form:
March 9,
2016
Received:
March 8,
2016
Footnotes
☆Disclaimers: There are no conflicts of interest, and there was no outside funding for this research. This abstract and research was presented at The Society of Critical Care Medicine Annual Congress in January 21 to 25, 2016.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
