Association between intensive care unit transfer delay and hospital mortality: A multicenter investigation

BACKGROUNDPrevious research investigating the impact of delayed intensive care unit (ICU) transfer on outcomes has utilized subjective criteria for defining critical illness. OBJECTIVETo investigate the impact of delayed ICU transfer using the electronic Cardiac Arrest Risk Triage (eCART) score, a previously published early warning score, as an objective marker of critical illness. DESIGNObservational cohort study. SETTINGMedical-surgical wards at 5 hospitals between November 2008 and January 2013. PATIENTSWard patients. INTERVENTIONNone. MEASUREMENTSeCART scores were calculated for all patients. The threshold with a specificity of 95% for ICU transfer (eCART60) denoted critical illness. A logistic regression model adjusting for age, sex, and surgical status was used to calculate the association between time to ICU transfer from first critical eCART value and in-hospital mortality. RESULTSA total of 3789 patients met the critical eCART threshold before ICU transfer, and the median time to ICU transfer was 5.4 hours. Delayed transfer (>6 hours) occurred in 46% of patients (n=1734) and was associated with increased mortality compared to patients transferred early (33.2% vs 24.5%, P<0.001). Each 1-hour increase in delay was associated with an adjusted 3% increase in odds of mortality (P<0.001). In patients who survived to discharge, delayed transfer was associated with longer hospital length of stay (median 13 vs 11 days, P<0.001). CONCLUSIONSDelayed ICU transfer is associated with increased hospital length of stay and mortality. Use of an evidence-based early warning score, such as eCART, could lead to timely ICU transfer and reduced preventable death. Journal of Hospital Medicine 2016;11:757-762. (c) 2016 Society of Hospital Medicine