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Intra-hospital transfers to a higher level of care: Contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS)

✍ Scribed by Gabriel J. Escobar; John D. Greene; Marla N. Gardner; Gregory P. Marelich; Bryon Quick; Patricia Kipnis

Publisher: John Wiley and Sons
Year: 2010
Tongue: English
Weight: 111 KB
Volume: 6
Category: Article
ISSN: 1553-5592
DOI: 10.1002/jhm.817

No coin nor oath required. For personal study only.

✦ Synopsis

Abstract

BACKGROUND:

Patients who experience intra‐hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single‐center studies or studies that employ ICU admissions as the denominator.

OBJECTIVE:

To employ automated bed history data to examine outcomes of intra‐hospital transfers using all hospital admissions as the denominator.

DESIGN:

Retrospective cohort study.

SETTING:

A total of 19 acute care hospitals.

PATIENTS:

A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008.

MEASUREMENTS:

Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre‐existing illness burden; outcomes were: 1) occurrence of intra‐hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS).

RESULTS:

A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers.