Public Release: 

Delayed transfer to the ICU increases risk of death in hospital patients

American Thoracic Society

ATS 2013, PHILADELPHIA ─ Delayed transfer to the intensive care unit (ICU) in hospitalized patients significantly increases the risk of dying in the hospital, according to a new study from researchers in Chicago.

"Early intervention improves outcomes for many of the conditions that are indications for inpatient transfer to the ICU. This suggests that delaying ICU transfer may increase the risk of death in these patients," said lead author Matthew Churpek, MD, MPH, of the University of Chicago Medical Center. "Using a vital sign-based early warning score, the Cardiac Arrest Risk Triage (CART) score, we examined outcomes after delayed transfer to the ICU and found that each one hour increase in transfer delay was associated with a 7% increase in the odds of dying in the ICU."

The results of the study will be presented at the ATS 2013 International Conference.

The study included 2,166 patients at an academic hospital who were transferred from medical-surgical wards to the ICU. Of these patients, 425 (20%) died during admission.

In a subset of 260 patients transferred to the ICU within 6 hours of a first critical CART score value, 71(27%) died during hospital admission, compared with 65 of the 143 (45%) patients for whom ICU transfer was delayed for more than 6 hours(p<0.001).

Further statistical analysis revealed that each one hour increase in delay in transfer to the ICU after reaching a critical CART score was associated with a significant (p<0.001)7% increase in the odds of ICU mortality, with the chance of dying in the hospital reaching 52% among patients in whom transfer to the ICU was delayed 18-24 hours after reaching the critical CART value.

"Use of an early warning score such as the CART score would allow for earlier identification of these patients and help decrease preventable in-hospital deaths associated with delayed transfer of ward patients to the ICU," said Dr. Churpek. "Further research may help determine what factors underlie delayed transfer to the ICU and whether earlier transfers can improve outcomes."

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* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 45392

Delayed Intensive Care Unit Transfer Is Associated With Increased Mortality In Ward Patients
Type: Late Breaking Abstract
Category: 02.08 - Improving Quality of Care (Including Guidelines, Comparative Effectiveness, Knowledge Translation, Information
Technology/Telemedicine) (BSHSR)
Authors: M.M. Churpek, T.C. Yuen, D.P. Edelson; University of Chicago - Chicago, IL/US

Abstract Body

RATIONALE: Early intervention improves outcomes in many conditions that are indications for intensive care unit (ICU) transfer, such as septic shock and respiratory failure. However, the impact of delayed ICU transfer on the mortality of critically ill ward patients is poorly characterized. We investigated the impact of delayed transfer by using the Cardiac Arrest Risk Triage (CART) score, a previously published vital sign-based early warning score, as an objective measure of critical illness. METHODS: We performed a cohort study at an academic hospital that included all patients admitted to the medical-surgical wards between November 2008 and January 2011. CART scores were calculated for all patients on the wards and the score cut-off corresponding to a specificity of 95% for ICU transfer was defined as the value denoting critical illness a priori. Time from when a patient first reached this CART score value until transfer to the ICU was calculated for each patient, up to a maximum of 24 hours. Patients who suffered a cardiac arrest on the wards with attempted resuscitation were counted as ICU transfers at the time of arrest. Logistic regression was used to calculate the change in odds of death in the ICU for each one-hour delay in ICU transfer time. RESULTS: A total of 54,032 admissions to the hospital wards occurred during the study period, including 2,166 patients transferred from the wards to the ICU. The median time from first critical CART score value to ICU transfer was 2.7 hours (n=403), and ICU mortality for these patients was 28%. ICU transfer was delayed for greater than six hours in 39% of these patients.

Each one hour increase in delay to ICU transfer was associated with a 7% increase in the odds of ICU mortality (p<0.001). This resulted in an ICU mortality of 21% in the group transferred within the first six hours of first reaching the critical CART score value to 52% in the group transferred 18-24 hours after the critical value.

CONCLUSIONS: Delayed transfer to the ICU is associated with a significant increase in ICU and hospital mortality. Real-time use of an evidence-based early warning score, such as the CART score, could identify critically ill patients on the wards earlier and potentially decrease preventable in-hospital death.

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