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Education, Teaching, and Quality Improvement |

Assessing Mortality in the Medical Intensive Care Unit of Interfacility Transferred MICU Patients

Nirav Patel, MD; Niusha Damaghi; Michael Stephen
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Drexel University School of Medicine, Philadelphia, PA


Chest. 2014;146(4_MeetingAbstracts):516A. doi:10.1378/chest.1991775
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of this study was to asses outcomes in patients in an academic MICU that were transferred from an outside hospital MICU. Transferring a patient to a tertiary care MICU is costly and the risks of the transfer may outweigh the benefits. This study assessed mortality of transferred patients. Furthermore, it assesses if patients have met their primary purpose post transfer, whether it was an improvement in their condition, or if the patients received an organ transplantation (Liver/ kidney).

METHODS: A retrospective single center study of inter-facility MICU transferred patients within the last year (1/8/2013 to 1/1/2014) was performed. Each patient's records were examined over the course of their ICU stay. Gathered data included APACHE score, demographics, medical condition, and outcomes of their illness

RESULTS: The over-all mortality of 48 patients transferred was 39% (19/48) with an average ICU stay of nine days. Sixteen of the 48 patients transferred were due to liver transplant evaluations. Ten out of 16 liver patients died in the hospital or in the ICU with a mortality of 63%. One patient received a liver during their hospital course. The rest of the patients either died, were removed from transplant list, or transferred to hospice care. Mortality rate was 42% of the hepatology patients transferred for specific interventions (banding, TACE, or NAC protocol). Lowest mortality rate were from patients transferred due to respiratory failure (29%) and status epilepticus (16.7%). There were no significant changes in vitals post transfer within 48 hours.

CONCLUSIONS: The highest mortality was seen among liver failure patients transferred specifically for a transplant evaluation. Patients with Non-cirrhotic/acute hepatitis, respiratory failure, and status epilepticus had more noticeable better outcomes.

CLINICAL IMPLICATIONS: Many patients admitted to the MICU in community hospitals may not have the proper resources or specialized care needed to treat such complicated medical conditions. There are many studies that have recommended structured guidelines for optimal inter-facility transfer of critically ill patients but few have assessed clinical outcomes post transfer

DISCLOSURE: The following authors have nothing to disclose: Nirav Patel, Niusha Damaghi, Michael Stephen

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