PURPOSE:To determine whether length of stay at a referring ICU (RLOS) has an impact on outcome in patients transferred to a tertiary care ICU.
METHODS:We retrospectively reviewed the Project Impact database of all adult medical or surgical patients admitted to our tertiary ICU. Patients transferred from outside ICUs from July 1, 2003-October 31, 2007 were eligible. In-hospital mortality (HM), duration of mechanical ventilation (DMV), ICU length of stay (ILOS) and hospital length of stay (HLOS) were the outcomes of interest. We explored associations between these outcomes and RLOS by chi-square analysis and classification and regression tree (CRT) analysis. Continuous variables were compared using the Mann-Whitney U test.
RESULTS:Of 314 eligible patients, 104 were excluded due to insufficient data, leaving 210 evaluable patients. The mean, median, and interquartile ranges (IQR) for ILOS, HLOS and DMV are given in table 1. The HM rate was 32%. Using a CRT analysis the cutoff value of > 7 days LOS in a transferring ICU was found to be associated with the outcomes of interest. There were 152 patients with a referring ICU LOS ≤; 7 days (72.4%) and 58 with RLOS > 7 days (27.6%). The two groups were similar in age and severity of illness on transfer by APACHE II and SAPS II scores. We defined longer lengths of ICU stay, hospital stay and mechanical ventilation (LILOS, LHLOS, LDMV respectively) as greater than the median. We found a significant association between longer referring ICU LOS and death (p=0.031), LILOS (p=0.001), LDMV (p=0.025), and LHLOS (p=0.047).(Table 2).
CONCLUSION:Longer LOS at the referring ICU (> 7 days) is associated with increased mortality, longer lengths of ICU stay, hospital stay, and mechanical ventilation.
CLINICAL IMPLICATIONS:These findings may reflect a beneficial impact of earlier access to specialized care. Referring clinicians may wish to consider expeditious transfer to tertiary care. It may be appropriate to account for referring ICU LOS in the application of benchmarking criteria to tertiary care centers.
DISCLOSURE:Terence Lonergan, None.