Delay of transfer from the intensive care unit: a prospective observational study of incidence, causes, and financial impact

Crit Care. 2013 Jul 4;17(4):R128. doi: 10.1186/cc12807.


Introduction: A paucity of literature exists regarding delays in transfer out of the intensive care unit. We sought to analyze the incidence, causes, and costs of delayed transfer from a surgical intensive care unit (SICU).

Methods: An IRB-approved prospective observational study was conducted from January 24, 2010, to July 31, 2010, of all 731 patients transferred from a 20-bed SICU at a large tertiary-care academic medical center. Data were collected on patients who were medically ready for transfer to the floor who remained in the SICU for at least 1 extra day. Reasons for delay were examined, and extra costs associated were estimated.

Results: Transfer to the floor was delayed in 22% (n = 160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean, 1.5 days; median, 2 days). The extra costs associated with delays were estimated to be $581,790 during the study period, or $21,547 per week. The most common reasons for delay in transfer were lack of available surgical-floor bed (71% (114 of 160)), lack of room appropriate for infectious contact precautions (18% (28 of 160)), change of primary service (Surgery to Medicine) (7% (11 of 160)), and lack of available patient attendant ("sitter" for mildly delirious patients) (3% (five of 160)). A positive association was found between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman rho = 0.27; P < 0.0001).

Conclusions: Delay in transfer from the SICU is common and costly. The most common reason for delay is insufficient availability of surgical-floor beds. Delay in transfer is associated with high hospital census. Further study of this problem is necessary.

Publication types

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

MeSH terms

  • Costs and Cost Analysis
  • Efficiency, Organizational
  • Hospital Bed Capacity
  • Hospital Costs*
  • Hospitals, University / economics
  • Hospitals, University / organization & administration
  • Humans
  • Intensive Care Units / economics*
  • Length of Stay / economics
  • Massachusetts
  • Patient Transfer / economics*
  • Prospective Studies
  • Time Factors