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Observational Study
. 2016 Nov;11(11):757-762.
doi: 10.1002/jhm.2630. Epub 2016 Jun 28.

Association between intensive care unit transfer delay and hospital mortality: A multicenter investigation

Matthew M Churpek  1 , Blair Wendlandt  2 , Frank J Zadravecz  2 , Richa Adhikari  2 , Christopher Winslow  3 , Dana P Edelson  2
Affiliations
Observational Study

Association between intensive care unit transfer delay and hospital mortality: A multicenter investigation

Matthew M Churpek et al. J Hosp Med. 2016 Nov.

Abstract

Background: Previous research investigating the impact of delayed intensive care unit (ICU) transfer on outcomes has utilized subjective criteria for defining critical illness.

Objective: To investigate the impact of delayed ICU transfer using the electronic Cardiac Arrest Risk Triage (eCART) score, a previously published early warning score, as an objective marker of critical illness.

Design: Observational cohort study.

Setting: Medical-surgical wards at 5 hospitals between November 2008 and January 2013.

Patients: Ward patients.

Intervention: None.

Measurements: eCART scores were calculated for all patients. The threshold with a specificity of 95% for ICU transfer (eCART ≥ 60) denoted critical illness. A logistic regression model adjusting for age, sex, and surgical status was used to calculate the association between time to ICU transfer from first critical eCART value and in-hospital mortality.

Results: A total of 3789 patients met the critical eCART threshold before ICU transfer, and the median time to ICU transfer was 5.4 hours. Delayed transfer (>6 hours) occurred in 46% of patients (n = 1734) and was associated with increased mortality compared to patients transferred early (33.2% vs 24.5%, P < 0.001). Each 1-hour increase in delay was associated with an adjusted 3% increase in odds of mortality (P < 0.001). In patients who survived to discharge, delayed transfer was associated with longer hospital length of stay (median 13 vs 11 days, P < 0.001).

Conclusions: Delayed ICU transfer is associated with increased hospital length of stay and mortality. Use of an evidence-based early warning score, such as eCART, could lead to timely ICU transfer and reduced preventable death. Journal of Hospital Medicine 2016;11:757-762. © 2016 Society of Hospital Medicine.

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Conflict of interest statement

and Source of Funding: This research was funded in part by an institutional Clinical and Translational Science Award grant (UL1 RR024999; PI: Dr. Julian Solway). Dr. Churpek is supported by a career development award from the National Heart, Lung, and Blood Institute (K08 HL121080). Drs. Churpek and Edelson have a patent pending (ARCD. P0535US.P2) for risk stratification algorithms for hospitalized patients. In addition, Dr. Edelson has received research support from Philips Healthcare (Andover, MA), research support from the American Heart Association (Dallas, TX) and Laerdal Medical (Stavanger, Norway). She has ownership interest in Quant HC (Chicago, IL), which is developing products for risk stratification of hospitalized patients.

Figures

Figure 1
Figure 1
Association between length of ICU transfer delay and hospital mortality.
Figure 2
Figure 2
Change in eCART score over time for the twelve hours prior to reaching the critical eCART value until ICU transfer for patients with delayed vs. non-delayed ICU transfer. Time 0 denotes first critical eCART value.
See this image and copyright information in PMC

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