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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 Jan; 8(1):13-9.JH

Abstract

BACKGROUND

Emergency department (ED) ward admissions subsequently transferred to the intensive care unit (ICU) within 24 hours have higher mortality than direct ICU admissions.

DESIGN, SETTING, PATIENTS

Describe risk factors for unplanned ICU transfer within 24 hours of ward arrival from the ED.

METHODS

Evaluation of 178,315 ED non-ICU admissions to 13 US community hospitals. We tabulated the outcome of unplanned ICU transfer by patient characteristics and hospital volume. We present factors associated with unplanned ICU transfer after adjusting for patient and hospital differences in a hierarchical logistic regression.

RESULTS

There were 4,252 (2.4%) non-ICU admissions transferred to the ICU within 24 hours. Admitting diagnoses most associated with unplanned transfer, listed by descending prevalence were: pneumonia (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.2-1.9), myocardial infarction (MI) (OR 1.5; 95% CI 1.2-2.0), chronic obstructive pulmonary disease (COPD) (OR 1.4; 95% CI 1.1-1.9), sepsis (OR 2.5; 95% CI 1.9-3.3), and catastrophic conditions (OR 2.3; 95% CI 1.7-3.0). Other significant predictors included: male sex, Comorbidity Points Score >145, Laboratory Acute Physiology Score ≥7, arriving on the ward between 11 PM and 7 AM. Decreased risk was found with admission to monitored transitional care units (OR 0.83; 95% CI 0.77-0.90) and to higher volume hospitals (OR 0.94 per 1,000 additional annual ED inpatient admissions; 95% CI 0.91-0.98).

CONCLUSIONS

ED patients admitted with respiratory conditions, MI, or sepsis are at modestly increased risk for unplanned ICU transfer and may benefit from better triage from the ED, earlier intervention, or closer monitoring to prevent acute decompensation. More research is needed to determine how intermediate care units, hospital volume, time of day, and sex affect unplanned ICU transfer. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine.

Authors+Show Affiliations

Division of Emergency Medicine and the Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California., USA. kdelgado@stanford.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

23024040

Citation

Delgado, M Kit, et al. "Risk Factors for Unplanned Transfer to Intensive Care Within 24 Hours of Admission From the Emergency Department in an Integrated Healthcare System." Journal of Hospital Medicine, vol. 8, no. 1, 2013, pp. 13-9.
Delgado MK, Liu V, Pines JM, et al. 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(1):13-9.
Delgado, M. K., Liu, V., Pines, J. M., Kipnis, P., Gardner, M. N., & Escobar, G. J. (2013). Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare system. Journal of Hospital Medicine, 8(1), 13-9. https://doi.org/10.1002/jhm.1979
Delgado MK, et al. 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(1):13-9. PubMed PMID: 23024040.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated healthcare system. AU - Delgado,M Kit, AU - Liu,Vincent, AU - Pines,Jesse M, AU - Kipnis,Patricia, AU - Gardner,Marla N, AU - Escobar,Gabriel J, Y1 - 2012/09/28/ PY - 2012/04/12/received PY - 2012/07/11/revised PY - 2012/08/10/accepted PY - 2012/10/2/entrez PY - 2012/10/2/pubmed PY - 2013/6/7/medline SP - 13 EP - 9 JF - Journal of hospital medicine JO - J Hosp Med VL - 8 IS - 1 N2 - BACKGROUND: Emergency department (ED) ward admissions subsequently transferred to the intensive care unit (ICU) within 24 hours have higher mortality than direct ICU admissions. DESIGN, SETTING, PATIENTS: Describe risk factors for unplanned ICU transfer within 24 hours of ward arrival from the ED. METHODS: Evaluation of 178,315 ED non-ICU admissions to 13 US community hospitals. We tabulated the outcome of unplanned ICU transfer by patient characteristics and hospital volume. We present factors associated with unplanned ICU transfer after adjusting for patient and hospital differences in a hierarchical logistic regression. RESULTS: There were 4,252 (2.4%) non-ICU admissions transferred to the ICU within 24 hours. Admitting diagnoses most associated with unplanned transfer, listed by descending prevalence were: pneumonia (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.2-1.9), myocardial infarction (MI) (OR 1.5; 95% CI 1.2-2.0), chronic obstructive pulmonary disease (COPD) (OR 1.4; 95% CI 1.1-1.9), sepsis (OR 2.5; 95% CI 1.9-3.3), and catastrophic conditions (OR 2.3; 95% CI 1.7-3.0). Other significant predictors included: male sex, Comorbidity Points Score >145, Laboratory Acute Physiology Score ≥7, arriving on the ward between 11 PM and 7 AM. Decreased risk was found with admission to monitored transitional care units (OR 0.83; 95% CI 0.77-0.90) and to higher volume hospitals (OR 0.94 per 1,000 additional annual ED inpatient admissions; 95% CI 0.91-0.98). CONCLUSIONS: ED patients admitted with respiratory conditions, MI, or sepsis are at modestly increased risk for unplanned ICU transfer and may benefit from better triage from the ED, earlier intervention, or closer monitoring to prevent acute decompensation. More research is needed to determine how intermediate care units, hospital volume, time of day, and sex affect unplanned ICU transfer. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine. SN - 1553-5606 UR - https://www.unboundmedicine.com/medline/citation/23024040/Risk_factors_for_unplanned_transfer_to_intensive_care_within_24_hours_of_admission_from_the_emergency_department_in_an_integrated_healthcare_system_ L2 - https://doi.org/10.1002/jhm.1979 DB - PRIME DP - Unbound Medicine ER -