Keywords :
Critically ill adults, Emergency service, Intensive care unit, Patient admission
Citation Information :
Bosco S, Sahni N, Jain A, Arora P, Raj V. Delayed Transfer of Critically Ill Patients from Emergency Department to Intensive Care Unit. Indian J Crit Care Med 2023; 27 (8):580-582.
Background and aim: Delay in the transfer of critically ill patients from the emergency department (ED) to intensive care units (ICUs) may worsen clinical outcomes. This prospective, observational study was done to find the incidence of delayed transfer.
Materials and methods: After approval from the institute ethics committee and written informed consent, all patients admitted to ICU from ED over 6 months were divided into groups I and II as patients getting transferred to ICU within 30 minutes of the decision or not, respectively. The factors affecting the immediate transfer and clinical outcome of all patients were noted. Monthly feedback was given to the ED team.
Results: Out of 52 ICU admissions from ED, 35 (67.3%) patients were not transferred within 30 minutes, and the most frequent factor preventing immediate transfer was ED-related (54%). A statistically significant difference was found in acute physiology and chronic health evaluation (APACHE II) score, clinical deterioration during transfer, longer duration of mechanical ventilation and length of stay, and higher mortality with patients transferred immediately to ICU. A reduction of 42.6% was noted in transfer time from the first month to the last month of study.
Conclusion: The incidence of delayed transfer of patients from ED to ICU was 67.3% with ED-related factors being the most frequent cause of delay (54.2%).
Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP, DELAY-ED study group. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 2007;35(6):1477–1483. DOI: 10.1097/01.CCM.0000266585.74905.5A.
Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, et al. Impact of delayed admission to intensive care units on mortality of critically ill patients: A cohort study. Crit Care 2011;15(1):R28. DOI: 10.1186/cc9975.
Richardson DB. Reducing patient time in emergency department. Med J Aust 2003;179(10):516–517. DOI: 10.5694/j.1326-5377.2003.tb05672.x.
Singer AJ, Thode HC Jr, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med 2011;18:1324–1329. DOI: 10.1111/j.1553-2712.2011.01236.
Young MP, Gooder VJ, McBride K, James B, Fisher ES. Inpatient transfers to the intensive care unit. Delays are associated with increased mortality and morbidity. J Gen Intern Med 2003;18(2): 77–83. DOI: 10.1046/j.1525-1497.2003.20441.x.
Churpek MM, Wendlandt B, Zadravecz FJ, Adhikari R, Winslow C, Edelson DP. Association between intensive care unit transfer delay and hospital mortality. A multicenter investigation. J Hosp Med 2016;11(11):757–762. DOI: 10.1002/jhm.2630.
Lin S, Ge S, He W, Zeng M. Association of delayed time in the emergency department with the clinical outcomes for critically ill patients. QJM 2021;114(5):311–117. DOI: 10.1093/qjmed/hcaa192.
Tilluckdharry L, Tickoo S, Amoateng–Adjepong Y, Manthous C. Outcomes of critically ill patients. Am J Emerg Med 2005;23(3): 336–339. DOI: 10.1016/j.ajem.2005.02.038.
Saukkonen KA, Varpula M, Rasanen P, Roine RP, Voipio–Pulkki LM, Pettila V. The effect of emergency department delay on outcome in critically ill medical patients: Evaluation using hospital mortality and quality of life at 6 months. J Intern Med 2006;260(6):586–591. DOI: 10.1111/j.1365-2796.2006.01716.x.
Soni KD, Kaushik G, Gupta A, Singh V, Kumar S, Sagar S. From emergency department to intensive care unit, does the delay matter to trauma patients? J Emerg Trauma Shock 2018;11(3):189–192. DOI: 10.4103/JETS.JETS_132_17.
Tran Q K, O'Connor J, Vesselinov R, Haase D, Duncan R, Aitken A, et al. The critical care resuscitation unit transfers more patients from emergency departments faster and is associated with improved outcomes. J Emerg Med 2020;58(2):280–289. DOI: 10.1016/j.jemermed.2019.09.041.
Duke G, Green J, Briedis J. Survival of critically ill medical patients is time–critical. Crit Care Resusc 2004;6(4):261–267. PMID: 16556104.
Cohen RI, Kennedy H, Amitrano B, Dillon M, Guigui S, Kanner A. A quality improvement project to decrease emergency department and medical intensive care unit transfer times. J Crit Care 2015;30(6):1331–1337. DOI: 10.1016/j.jcrc.2015.07.017.
Simchen E, Sprung CL, Galai N, Zitser-Gurevich Y, Bar-Lavi Y, Gurman G, et al. Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care beds. Crit Care Med 2004;32(8):1654–1661. DOI: 10.1097/01.ccm.0000133021.22188.35.
Silich SJ, Wetz RV, Riebling N, Coleman C, Khoueiry G, Abi Rafeh N, et al. Using six sigma methodology to reduce patient transfer times from floor to critical-care beds. J Healthcare Qual 2012;34:44–54. DOI: 10.1111/j.1945-1474DOI.2011.00184.x.
