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J Hosp Med. 2011 Feb;6(2):74-80. doi: 10.1002/jhm.817. Epub 2010 Dec 17.

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 information

1
Hospital Operations Research, Division of Research, Oakland, California, USA. gabriel.escobar@kp.org

Abstract

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.

PMID:
21290579
DOI:
10.1002/jhm.817
[Indexed for MEDLINE]

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