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

Background: Previous research investigating the impact of delayed intensive care unit (ICU) transfer on outcomes has utilized subjective criteria for defining critical illness.

Objective: To 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.

Design: Observational cohort study.

Setting: Medical-surgical wards at 5 hospitals between November 2008 and January 2013.

Patients: Ward patients.

Intervention: None.

Measurements: eCART scores were calculated for all patients. The threshold with a specificity of 95% for ICU transfer (eCART ≥ 60) 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.

Results: A 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).

Conclusions: Delayed 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. © 2016 Society of Hospital Medicine.