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VOLUME 23 , ISSUE 3 ( March, 2019 ) > List of Articles

ORIGINAL ARTICLE

Transfer Time from the Intensive Care Unit and Patient Outcome: A Retrospective Analysis from a Tertiary Care Hospital in India

Sharmila Chatterjee, SK Todi

Keywords : Intensive care, length of stay, mortality, readmission, transfer time

Citation Information : Chatterjee S, Todi S. Transfer Time from the Intensive Care Unit and Patient Outcome: A Retrospective Analysis from a Tertiary Care Hospital in India. Indian J Crit Care Med 2019; 23 (3):115-121.

DOI: 10.5005/jp-journals-10071-23132

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and aims: Patients’ outcome after ICU transfer reflect hospital\'s post-ICU care status. This study assessed association of after-hour ICU transfer on patient outcome. Subjects and methods: Single-centre, retrospective analysis of data between March 2016 to April 2017 at a tertiary-care hospital in India. Patient data were collected on all consecutive ICU admissions during study period. Patients were categorized according to ICU transfer time into daytime (08:00–19:59 hours) and after-hour (20:00–07:59 hours). Patients transferred to other ICUs/hospitals, died in ICU, or discharged home from ICU were excluded. Only first ICU admission was considered for outcome analysis. Primary outcome-hospital mortality; secondary outcomes-ICU re-admission and hospital length of stay (LOS). All analysis were adjusted for illness severity. Results: Of 1857 patients admitted during study period,1356 were eligible for study; 53.9% were males and 383(28%) patients transferred during after-hour. Mean age of two groups (daytime vs. after-hour 65.7±15.2 vs. 66.3±16.2 years) was similar (p = 0.7). Mean APACHE IV score was comparable between daytime vs. after-hour transfers (45.6±20.4 vs 46.8±22; p = 0.05). Unadjusted hospital mortality rate of after-hour-transfers was significantly higher compared to daytime-transfers (7.1% vs. 4.1%; p = 0.02). After adjustment with illness severity, after-hour-transfers were associated with significantly higher hospital mortality compared to daytime-transfers (aOR1.7, 95%CI 1.1,2.8; p = 0.04). Median duration of hospital LOS and ICU re-admission though higher for after-hour-transfers, was not statistically significant in adjusted analysis (aORhospital-LOS1.1, 95% CI 0.8, 1.4, p = 0.5; aORreadmission 1.6, 95% CI 0.9,2.7; p = 0.06 respectively). Conclusion: After-hour-transfers from ICU is associated with significantly higher hospital mortality. Hospital LOS and readmission rates are similar for daytime and after-hour-transfers.


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  1. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100(6):1619– 36.
  2. Beck DH, Taylor BL, Millar B, Smith GB. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 1997;25(1):9–15.
  3. Azoulay E, Adrie C, De Lassence A, Pochard F, Moreau D, Thiery G, et al. Determinants of postintensive care unit mortality: a prospective multicenter study. Crit Care Med 2003; 31(2): 428–32.
  4. Moreno R, Miranda DR, Matos R, Fevereiro T. Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge. Intensive Care Med 2001;27 (6):999–1004.
  5. Durbin CG, Kopel RF. A case-control study of patients readmitted to the intensive care unit. Crit Care Med 1993;21:1547-53.
  6. Rosenberg AL, Watts CW. Patients readmitted to ICUs. A systematic review of risk factors and outcomes. Chest 2000;118:492-502.
  7. Beck DH, McQuillan P, Smith GR. Waiting for the break of dawn? The effects of discharge time, discharge TISS scores and discharge facility on hospital mortality after intensive care. Intensive Care Med 2002;28:1287-93.
  8. Singh MY, Nayyar V, Clark PT, Kim C. Does after-hours discharge of ICU patients influence outcome? Crit Care Resusc 2010;12(3):156–61.
  9. Pilcher DV, Duke GJ, George C, Bailey MJ, Hart G. After-hours discharge from intensive care increases the risk of readmission and death. Anaesth Intensive Care 2007;35(4):477–85.
  10. Hanane T, Keegan MT, Seferian EG, Gajic O, Afessa B. The association between nighttime transfer from the intensive care unit and patient outcome. Crit Care Med 2008;36(8):2232–7.
  11. Goldfrad C, Rowan K. Consequences of discharges from intensive care at night. Lancet 2000; 355:1138–42.
  12. Obel N, Schierbeck J, Pedersen L, Storgaard M, Pedersen C, Sorensen HT, et al. Mortality after discharge from the intensive care unit during the early weekend period: a population-based cohort study in Denmark. Acta Anaesthesiol Scand 2007;51(9):1225-30.
  13. Laupland KB, Shahpori R, Kirkpatrick AW, Stelfox HT. Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings. J Crit Care 2008; 23(3):317-24.
  14. Duke GJ, Green JV, Briedis JH. Night-shift discharge from intensive care unit increases the mortality-risk of ICU survivors. Anaesth Intensive Care 2004;32(5):697-701.
  15. Priestap FA, Martin CM. Impact of intensive care unit discharge time on patient outcome. Crit Care Med 2006;34(12):2946-51.
  16. Uusaro A, Kari A, Ruokonen E: The effects of ICU admission and discharge times on mortality in Finland. Intensive Care Med 2003;2144–48.
  17. Bristow PJ. Discharges out of hours are associated with increased mortality. Anaesth Intensive Care 2003;31:222.
  18. Dahhan T, Jamil M, Al-Tarifi A, Abouchala N, Kherallah M. Validation of the APACHE IV scoring system in patients with severe sepsis and comparison with the APACHE II system. Crit Care 2009;13(Suppl 1):P511.
  19. Tobin AE, Santamaria JD. After-hours discharges from intensive care are associated with increased mortality. Med J Aust 2006;184(7):334-7.
  20. Azevedo LC, de Souza IA, Zygun DA, Stelfox HT, Bagshaw SM. Association between nighttime discharge from the intensive care unit and hospital mortality: a multi-center retrospective cohort study. BMC Health Serv Res 2015;15:378.
  21. Santamaria JD, Duke GJ, Pilcher DV, Cooper DJ, Moran J, Bellomo R; Discharge and readmission evaluation (DARE) study. The timing of discharge from the intensive care unit and subsequent mortality. A prospective, multicenter study. Am J Respir Crit Care Med 2015; 191(9): 1033-9.
  22. Yang S, Wang Z, Liu Z, Wang J, Ma L. Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis. Crit Care 2016;20(1):390.
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