Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity

J Gen Intern Med. 2003 Feb;18(2):77-83. doi: 10.1046/j.1525-1497.2003.20441.x.


Objective: To examine if delayed transfer to the intensive care unit (ICU) after physiologic deterioration is associated with increased morbidity and mortality.

Design: Inception cohort.

Setting: Community hospital in Ogden, Utah.

Patients: Ninety-one consecutive inpatients with noncardiac diagnoses at the time of emergent transfer to the ICU. We determined the time when each patient first met any of 11 pre-specified physiologic criteria. We classified patients as "slow transfer" when patients met a physiologic criterion 4 or more hours before transfer to the ICU. Patients were followed until discharge.

Interventions: None.

Measurements: In-hospital mortality, functional status at hospital discharge, hospital resources.

Main results: At the time when the first physiologic criterion was met on the ward, slow- and rapid-transfer patients were similar in terms of age, gender, diagnosis, number of days in hospital prior to ICU transfer, prehospital functional status, and APACHE II scores. By the time slow-transfer patients were admitted to the ICU, they had significantly higher APACHE II scores (21.7 vs 16.2; P =.002) and were more likely to die in-hospital (41% vs 11%; relative risk [RR], 3.5; 95% confidence interval [95% CI], 1.4 to 9.5). Slow-transfer patients were less likely to have had their physician notified of deterioration within 2 hours of meeting physiologic criteria (59% vs 31%; P =.001) and less likely to have had a bedside physician evaluation within the first 3 hours after meeting criteria (23% vs 83%; P =.001).

Conclusions: Slow transfer to the ICU of physiologically defined high-risk hospitalized patients was associated with increased risk of death. Slow response to physiologic deterioration may explain these findings.

Publication types

  • Research Support, Non-U.S. Gov't
  • Comment

MeSH terms

  • Aged
  • Female
  • Health Status Indicators
  • Hospital Mortality*
  • Hospitals, Community
  • Hospitals, Teaching
  • Humans
  • Intensive Care Units / organization & administration
  • Intensive Care Units / statistics & numerical data*
  • Male
  • Patient Transfer*
  • Time Factors
  • Utah