PURPOSE:Patients are admitted to intensive care units (ICU) in tertiary academic centers either through the emergency department (ED) or as a transfer from another healthcare facility (HCF). Such patients may have different severity of illness on admission and this may translate into variable outcomes and expenses. The purpose of this study was to evaluate the length of stay in our facility following ICU admission either through our ED or following transfer from another HCF.
METHODS:A retrospective chart review was completed on patients who were admitted to our medical ICU service. Group 1 included patients who were admitted through our ED and group 2 included patients who were transferred from another HCF from January to June 2006. The primary outcome was length of stay (LOS) in the ICU. Secondary outcomes were LOS in the hospital, predicted mortality risk on admission (using simplified acute physiology expanded score II), adverse events such as readmission to ICU, incidence of acute renal failure (ARF) and number of invasive procedures (central and arterial lines, chest tubes and pulmonary artery catheters).
RESULTS:180 patients were included in group 1 and 58 patients in group 2.Patients in group 2 had a higher predicted mortality on admission (49.91% mean risk of death, SD: +- 26.808) compared to group 1 (mean risk of death 19.28 with SD: +- 21.873, p<0.0001, 95% C.I.: 15.731–29.510). Patients in group 2 had a mean LOS in the ICU 10.60 days compared to 6.50 days for patients in group 1 (p=0.005, 95% C.I.: 1.23–6.97). Group 2 patients had mean total hospital LOS 13.11 days versus 9.39 days (p=0.0162, 95% C.I.: 0.69–6.75). Group 2 patients had higher incidence of ARF (28% versus 14%, p=0.019), and more invasive procedures done (33% versus 19%, p=0.0007).Readmission to ICU was not different.
CONCLUSION:In our medical ICU, patients admitted from an outlying HCF were sicker, had a longer LOS, more invasive procedures and more complications.
CLINICAL IMPLICATIONS:Patients admitted from outlying HCF may result in increased hospital costs.
DISCLOSURE:Georgios Chrysochoou, No Financial Disclosure Information; No Product/Research Disclosure Information