Abstract
Background
The aim of this study is to evaluate the characteristics of unplanned transfers of adult patients from hospital wards to a neurological intensive care unit (NICU).
Methods
We retrospectively reviewed consecutive unplanned transfers from hospital wards to the NICU at our institution over a 3-year period. In-hospital mortality rates were compared between patients readmitted to the NICU (“bounce-back transfers”) and patients admitted to hospital wards from sources other than the NICU who were then transferred to the NICU (“incident transfers”). We also measured clinical characteristics of transfers, including source of admission and indication for transfer.
Results
A total of 446 unplanned transfers from hospital wards to the NICU occurred, of which 39 % were bounce-back transfers. The in-hospital mortality rate associated with all unplanned transfers to the NICU was 17 % and did not differ significantly between bounce-back transfers and incident transfers. Transfers to the NICU within 24 h of admission to a floor service accounted for 32 % of all transfers and were significantly more common for incident transfers than bounce-back transfers (39 vs. 21 %, p = .0002). Of patients admitted via the emergency department who had subsequent incident transfers to the NICU, 50 % were transferred within 24 h of admission.
Conclusions
Unplanned transfers to an NICU were common and were associated with a high in-hospital mortality rate. Quality improvement projects should target the triage process and transitions of care to the hospital wards in order to decrease unplanned transfers of high-risk patients to the NICU.
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References
Groeger JS, Guntupalli KK, Strosberg M, et al. Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization. Crit Care Med. 1993;21:279–91.
Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA. Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med. 2006;34:1016–24.
Escobar GJ, Greene JD, Gardner MN, Marelich GP, Quick B, Kipnis P. Intra-hospital transfers to a higher level of care: contribution to total hospital and intensive care unit (ICU) mortality and length of stay (LOS). J Hosp Med. 2011;6:74–80.
Suarez JI, Zaidat OO, Suri MF, et al. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med. 2004;32:2311–7.
Goldhill DR, McNarry AF, Hadjianastassiou VG. Tekkis PP. The longer patients are in hospital before Intensive Care admission the higher their mortality. Intensive Care Med. 2004;30:1908–13.
Brown SES, Ratcliffe SJ, Kahn JM, Halpern SD. The epidemiology of intensive care unit readmissions in the United States. Am J Respir Crit Care Med. 2012;185:955–64.
Cooper GS, Sirio CA, Rotondi AJ, Shepardson LB, Rosenthal GE. Are readmissions to the intensive care unit a useful measure of hospital performance? Med Care. 1999;37:399–408.
Goldhaber S, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–9.
Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA. 2014;311:1308–16.
Baigelman W, Katz R, Geary G. Patient readmission to critical care units during the same hospitalization at a community teaching hospital. Intensive Care Med. 1983;9:253–6.
Escarce JJ, Kelley MA. Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score. JAMA. 1990;264:2389–94.
Young MP, Gooder VJ, McBride K, James B, Fisher ES. Inpatient transfers to the intensive care unit. J Gen Intern Med. 2003;18:77–83.
Bapoje SR, Gaudiani JL, Narayanan V, Albert RK. Unplanned transfers to a medical intensive care unit: causes and relationship to preventable errors in care. J Hosp Med. 2011;6:68–72.
Edbrooke DL, Minelli C, Mills GH, et al. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis. Crit Care. 2011;15:R56.
Liu V, Kipnis P, Rizk NW, Escobar GJ. Adverse outcomes associated with delayed intensive care unit transfers in an integrated healthcare system. J Hosp Med. 2012;7:224–30.
Delgado MK, Liu V, Pines JM, Kipnis P, Gardner MN, Escobar GJ. Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare system. J Hosp Med. 2013;8:13–9.
Gajic O, Malinchoc M, Comfere TB, et al. The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation. Crit Care Med. 2008;36:676–82.
Ouanes I, Schwebel C, Français A, et al. A model to predict short-term death or readmission after intensive care unit discharge. J Crit Care. 2012;27:422e1–9.
Esmonde L, McDonnell A, Ball C, et al. Investigating the effectiveness of critical care outreach services: a systematic review. Intensive Care Med. 2006;32:1713–21.
Bellomo R, Warrillow S, Reade M. Why we should be wary of single-center trials. Crit Care Med. 2009;37:3114–9.
Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999;30:1538–41.
Hofhuis JGM, Spronk PE, van Stel HF, Schrijvers GJP, Rommes JH, Bakker J. The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study. Chest. 2008;133:377–85.
Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiat. 2008;30:421–34.
Knaus W, Wagner D, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619–36.
Disclosure
Dr. Gold, Dr. Mayer, Dr. Lennihan report no disclosure. Dr. Claassen reports serving on the advisory board for Actelion for a planned study unrelated to the content of this manuscript. Dr. Willey reports no disclosure.
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Gold, C.A., Mayer, S.A., Lennihan, L. et al. Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit. Neurocrit Care 23, 159–165 (2015). https://doi.org/10.1007/s12028-015-0123-z
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DOI: https://doi.org/10.1007/s12028-015-0123-z