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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)
Author(s) -
Escobar Gabriel J.,
Greene John D.,
Gardner Marla N.,
Marelich Gregory P.,
Quick Bryon,
Kipnis Patricia
Publication year - 2011
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.817
Subject(s) - medicine , emergency medicine , intensive care unit , retrospective cohort study , hospital medicine , acute care , hospital care , hospital admission , intensive care , pediatrics , intensive care medicine , health care , economics , economic growth
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. CONCLUSIONS: Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS. Journal of Hospital Medicine 2010;. © 2010 Society of Hospital Medicine.