Most critically ill medical patients who arrive at the emergency department (ED) are directly admitted to the intensive care unit (ICU). However, some of these patients are admitted to a medical floor, only to be transferred to the ICU later on. These unplanned ICU transfers have a high in-hospital case-fatality rate, exceeding 55 percent. A new study found that even when the transfer was made within the first 24 hours of admission, there was a high risk of mortality.
Researchers matched 6,369 patients with unplanned medical ICU transfers within 24 hours of admission to a floor from the ED with the same number of medical patients admitted directly to the ICU from the ED. Patients were grouped into 44 broad “primary medical conditions” and had scores calculated based on laboratory results and coexisting conditions. Careful attention was paid to identifying the time elapsed from admission to unplanned ICU transfer.
The study found that more than 5 percent of patients admitted through the ED eventually had an unplanned ICU transfer. Such patients had longer stays than did patients directly admitted to the ICU (5 vs. 4.1 days). Unplanned transfer patients also had a higher case-fatality rate (11.6 vs. 8.5 percent) than those with direct ICU admissions. These patients had a high risk of death even when they were transferred within 8 hours of being admitted to the medical floor. Also, the odds of death among unplanned transfer patients increased as the elapsed time between admission and ICU transfer became longer. Unplanned transfers were associated with excess mortality among patients admitted with respiratory infections and gastrointestinal bleeding. However, no such differences were observed for patients admitted with heart attack, sepsis, or stroke. The study was supported in part by the Agency for Healthcare Research and Quality (HS18480).
See “Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system,” by Vincent Liu, M.D., M.S., Patricia Kipnis, Ph.D., Norman W. Rizk, M.D., and Gabriel J. Escobar, M.D., in the March 2012 Journal of Hospital Medicine 7(3), pp. 224-230.
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