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Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit.
J Crit Care. 2009 Sep; 24(3):379-86.JC

Abstract

PURPOSE

The study aimed to examine the effect of interhospital transfer on resource utilization and clinical outcomes at a tertiary pediatric intensive care unit (PICU) among patients with sepsis or respiratory failure.

MATERIALS AND METHODS

Data on 2146 consecutive admissions with respiratory failure or sepsis to the PICU were analyzed. Data included demographics, admission source, and outcomes. Admission source was classified as interhospital transfer from the emergency departments (ED), wards, or PICUs of referring hospitals; or from the study hospital ED (direct).

RESULTS

Compared with direct admissions, inter-PICU transfers had higher crude mortality (odds ratio, 1.93; 95% confidence interval, 1.31-2.84) but not significant mortality difference (odds ratio, 1.16; 95% confidence interval, 0.71-1.86) after adjusting for illness severity, age, and sex. Conversely, ED transfers had lower PICU mortality than direct ED admissions. Children with transfer admissions stayed significantly longer and used more intensive care technology in the study PICU than children directly admitted (P < .01). In comparisons within quartiles of mortality risk, inter-PICU transfers had longer hospitalization and higher mortality in all but the highest quartile.

CONCLUSIONS

Interhospital transfer, particularly inter-PICU transfer, was associated with significant hospital resource consumption that often correlated with admission illness severity. Future prospective studies should identify determinants of pretransfer illness severity and investigate decision making underlying interhospital transfer.

Authors+Show Affiliations

Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI 48109, USA. fodetola@med.umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19327327

Citation

Odetola, Folafoluwa O., et al. "Effect of Interhospital Transfer On Resource Utilization and Outcomes at a Tertiary Pediatric Intensive Care Unit." Journal of Critical Care, vol. 24, no. 3, 2009, pp. 379-86.
Odetola FO, Clark SJ, Gurney JG, et al. Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit. J Crit Care. 2009;24(3):379-86.
Odetola, F. O., Clark, S. J., Gurney, J. G., Dechert, R. E., Shanley, T. P., & Freed, G. L. (2009). Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit. Journal of Critical Care, 24(3), 379-86. https://doi.org/10.1016/j.jcrc.2008.11.007
Odetola FO, et al. Effect of Interhospital Transfer On Resource Utilization and Outcomes at a Tertiary Pediatric Intensive Care Unit. J Crit Care. 2009;24(3):379-86. PubMed PMID: 19327327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit. AU - Odetola,Folafoluwa O, AU - Clark,Sarah J, AU - Gurney,James G, AU - Dechert,Ronald E, AU - Shanley,Thomas P, AU - Freed,Gary L, Y1 - 2009/02/12/ PY - 2008/06/23/received PY - 2008/11/24/revised PY - 2008/11/24/accepted PY - 2009/3/31/entrez PY - 2009/3/31/pubmed PY - 2009/12/16/medline SP - 379 EP - 86 JF - Journal of critical care JO - J Crit Care VL - 24 IS - 3 N2 - PURPOSE: The study aimed to examine the effect of interhospital transfer on resource utilization and clinical outcomes at a tertiary pediatric intensive care unit (PICU) among patients with sepsis or respiratory failure. MATERIALS AND METHODS: Data on 2146 consecutive admissions with respiratory failure or sepsis to the PICU were analyzed. Data included demographics, admission source, and outcomes. Admission source was classified as interhospital transfer from the emergency departments (ED), wards, or PICUs of referring hospitals; or from the study hospital ED (direct). RESULTS: Compared with direct admissions, inter-PICU transfers had higher crude mortality (odds ratio, 1.93; 95% confidence interval, 1.31-2.84) but not significant mortality difference (odds ratio, 1.16; 95% confidence interval, 0.71-1.86) after adjusting for illness severity, age, and sex. Conversely, ED transfers had lower PICU mortality than direct ED admissions. Children with transfer admissions stayed significantly longer and used more intensive care technology in the study PICU than children directly admitted (P < .01). In comparisons within quartiles of mortality risk, inter-PICU transfers had longer hospitalization and higher mortality in all but the highest quartile. CONCLUSIONS: Interhospital transfer, particularly inter-PICU transfer, was associated with significant hospital resource consumption that often correlated with admission illness severity. Future prospective studies should identify determinants of pretransfer illness severity and investigate decision making underlying interhospital transfer. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/19327327/Effect_of_interhospital_transfer_on_resource_utilization_and_outcomes_at_a_tertiary_pediatric_intensive_care_unit_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(08)00251-7 DB - PRIME DP - Unbound Medicine ER -