Delay of transfer from the intensive care unit: a prospective observational study of incidence, causes, and financial impact

Abstract

IntroductionA paucity of literature exists regarding delays in transfer out of the intensive care unit. We sought to analyze the incidence, causes, and costs of delayed transfer from a surgical intensive care unit (SICU).MethodsAn IRB-approved prospective observational study was conducted from January 24, 2010, to July 31, 2010, of all 731 patients transferred from a 20-bed SICU at a large tertiary-care academic medical center. Data were collected on patients who were medically ready for transfer to the floor who remained in the SICU for at least 1 extra day. Reasons for delay were examined, and extra costs associated were estimated.ResultsTransfer to the floor was delayed in 22% (n = 160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean, 1.5 days; median, 2 days). The extra costs associated with delays were estimated to be $581,790 during the study period, or $21,547 per week. The most common reasons for delay in transfer were lack of available surgical-floor bed (71% (114 of 160)), lack of room appropriate for infectious contact precautions (18% (28 of 160)), change of primary service (Surgery to Medicine) (7% (11 of 160)), and lack of available patient attendant ("sitter" for mildly delirious patients) (3% (five of 160)). A positive association was found between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman rho = 0.27; P < 0.0001).ConclusionsDelay in transfer from the SICU is common and costly. The most common reason for delay is insufficient availability of surgical-floor beds. Delay in transfer is associated with high hospital census. Further study of this problem is necessary.

Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after‐hours with day transfers: an exploratory, prospective cohort study

“…These delays were also significantly longer for the after-hours transfer group (P < 0Á001). This concurs with the finding by Johnson et al (2013) finding that delays to transfer were significantly more likely to occur during night shifts, between 19Á00-06Á59 (21% vs. 12%), although they were unable to determine the human and organizational factors, which contributed to these excessive delays at the study site. Further research is required to extend the findings of this study by investigating the care and treatment received by patients following a decision of 'fully ready for ward care' whilst awaiting transfer.…”

High-Cost Patients: Hot-Spotters Don’t Explain the Half of It

“…53 With increased ICU bed supply, patients who are not critically ill and those who are unlikely to survive regardless of ICU care may nevertheless be admitted to ICUs, 54 highlighting the need for policies that incentivize the judicious use of ICU resources. Avoiding delays in transfer from the ICU to regular nursing floors 55,56 and appropriate initiation of palliative care may also reduce costs.…”

Sustaining critical care: using evidence-based simulation to evaluate ICU management policies

“…Limitations in the number of ICU staff, spaces within hospitals, government regulations and high costs associated with adding more beds to ICUs are mentioned as main reasons that hinder expansion of ICUs [1,38,39]. 5 Expanding General Ward Capacity: Inadequate availability of beds in the general ward is seen as a reason for prolonged ICU stay, which in turn may cause blocked access to ICU beds [40,41]. As such, expanding general ward capacity is considered as another policy to free blocked ICU beds.…”

“…As such, expanding general ward capacity is considered as another policy to free blocked ICU beds. 6 ICU Direct Discharge Home: Johnson et al (2013) propose directly discharging ICU patient home from ICU in instances where they have waited for a ward bed for a long time [40]. 7 Discharge Home without Admitting to ICU: Armony et al (2014) propose that patients who have waited long enough for admission to ICU in another department may have recovered and no longer need admission to ICU, and as such may be ready to be discharged [42].…”