OBJECTIVE: To examine if delayed transfer to the intensive care unit (ICU) after physiologic deterioration is associated with increased morbidity and mortality.
DESIGN: Inception cohort.
SETTING: Community hospital in Ogden, Utah.
PATIENTS: Ninety-one consecutive inpatients with noncardiac diagnoses at the time of emergent transfer to the ICU. We determined the time when each patient first met any of 11 pre-specified physiologic criteria. We classified patients as “slow transfer” when patients met a physiologic criterion 4 or more hours before transfer to the ICU. Patients were followed until discharge.
MEASUREMENTS: In-hospital mortality, functional status at hospital discharge, hospital resources.
MAIN RESULTS: At the time when the first physiologic criterion was met on the ward, slow- and rapid-transfer patients were similar in terms of age, gender, diagnosis, number of days in hospital prior to ICU transfer, prehospital functional status, and APACHE II scores. By the time slow-transfer patients were admitted to the ICU, they had significantly higher APACHE II scores (21.7 vs 16.2; P=.002) and were more likely to die inhospital (41% vs 11%; relative risk [RR], 3.5; 95% confidence interval [95% CI], 1.4 to 9.5). Slow-transfer patients were less likely to have had their physician notified of deterioration within 2 hours of meeting physiologic criteria (59% vs 31%; P=.001) and less likely to have had a bedside physician evaluation within the first 3 hours after meeting criteria (23% vs 83%; P=.001).
CONCLUSIONS: Slow transfer to the ICU of physiologically defined high-risk hospitalized patients was associated with increased risk of death. Slow response to physiologic deterioration may explain these findings.
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Funding for this project was provided in part by the McKay-Dee Foundation of Ogden, Utah
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Young, M.P., Gooder, V.J., McBride, K. et al. Inpatient transfers to the intensive care unit. J GEN INTERN MED 18, 77–83 (2003). https://doi.org/10.1046/j.1525-1497.2003.20441.x
- intensive care unit
- physiologic monitoring
- length of stay
- APACHE II score