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

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 and April 2017 was performed 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 ?rst ICU admission was considered for outcome analysis. Primary outcome-hospital mortality; secondary outcomes-ICU readmission 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; out of which 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 readmission though higher for after-hour-transfers, was not statistically significant in adjusted analysis (aOR hospitalLOS 1.1, 95% CI 0.8, 1.4, p = 0.5; aOR readmission 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. How to cite this article Chatterjee S, Sinha S et al ., 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.

After-Hours/Nighttime Transfers Out of the Intensive Care Unit and Patient Outcomes: A Systematic Review and Meta-Analysis

“…Thirty-one cohort studies from 1993-2018 were included with a total patient population of 1,418,924 (Table 1, and Figure S1, Table S2, and Table S3 of the Online Supplement). 5,10 –13,16,19,20,22,28 –49 Ten studies had duplication of existing datasets. 6 –9,50 –55 There were no randomized studies.…”

“…Thirteen (42%) studies included either adjustment or exclusion for treatment limitations (either do-not-resuscitate orders, comfort measures, withdrawal of life support, palliative patients) in their study design. 10,13,16,20,22,30 –33,36,38,42,49 Fourteen studies (45%) included information on the presence of either step-down, intermediate care, or high-dependency units. 5,10,12,13,19,30,31,35,41 –43,45,46,48…”

“…10,13,16,20,22,30 –33,36,38,42,49 Fourteen studies (45%) included information on the presence of either step-down, intermediate care, or high-dependency units. 5,10,12,13,19,30,31,35,41 –43,45,46,48…”

“…Recent contemporary literature on this topic, including large registry data from Sweden, continue to be published with mixed findings. 10 –13…”

Can Neuron Specific Enolase Be a Diagnostic Biomarker for Neuronal Injury in COVID-19?

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