A small percentage of patients admitted to hospital beds from emergency rooms — about 5 percent, according to recent studies — are then transferred to intensive care units due to an unexpected decline in their condition. What is striking about these so-called unplanned ICU transfers is that they account for 25 percent of all in-hospital deaths.
In a study (subscription required) published late last week in the Journal of Hospital Medicine, researchers led by M. Kit Delgado, MD, an emergency medicine physician at Stanford Hospital & Clinics, determined some of the risk factors for such transfers when they occur within 24 hours of patients being moved from the ER to a hospital bed. (About half of all unplanned ICU transfers happen within this time frame.)
The implications are that we need to figure out what is happening with patients with respiratory diseases in particular ...
The researchers found, among other things, that the risk was higher during overnight nursing shifts. It was lower among female patients and in high-volume hospitals. But what really stood out was this: Respiratory conditions, such as pneumonia and chronic obstructive pulmonary disease, accounted for nearly half — 47 percent — of all conditions linked to the increased risk of unplanned ICU transfer.
About the study, Delgado told me:
The implications are that we need to figure out what is happening with patients with respiratory diseases in particular in terms of initial resuscitation, monitoring and determining the appropriate level of hospital care. We have found in previous research that these respiratory patients who experience an unplanned transfer to the ICU have higher mortality than those who are directly admitted. Perhaps with better initial resuscitation and closer monitoring, these unplanned transfers can be prevented, and lives can be saved.
The study was based on three years of admissions data at 13 Kaiser Permanente hospitals.