Inpatient Transfers to the Intensive Care Unit

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.