Research Activities, February 2014
Emergency department patients with heart attack, respiratory conditions, or sepsis at risk of unplanned transfer to the ICU
Emergency department (ED) patients who are admitted to the hospital and require unplanned transfer to the intensive care unit (ICU) within 24 hours of arrival on the ward have previously been found to have higher case-fatality rates than do patients admitted directly to the ICU from the ED. It is possible that with better recognition and intervention in the ED, a portion of these unplanned ICU transfers and their subsequent adverse outcomes could be prevented, suggest researchers in a new study. They assessed 4,252 patients who were admitted to the ICU from the ED within 24 hours of arriving at the ED.
The investigators found that ED patients admitted with respiratory conditions, heart attack or sepsis were at relatively high risk of unplanned ICU transfer. In their evaluation of 178,315 ED non-ICU admissions to 13 Kaiser Permanente Northern California community hospitals, researchers found an average unplanned ICU transfer rate of 1 in 42.
One in 30 ED patients admitted for pneumonia, and 1 in 33 admitted for chronic obstructive pulmonary disease were transferred to the ICU within 24 hours. Although less frequent than hospitalizations for respiratory conditions, patients admitted with sepsis were at the highest risk of unplanned ICU transfer (1 in 17 ED non-ICU hospitalizations). Both heart attack and stroke patients also had high risks of unplanned ICU transfer.
Patients with the aforementioned conditions might benefit from better triage from the ED, earlier intervention, or closer monitoring to prevent acute worsening of their condition. However, since the case-fatality rate with unplanned ICU transfer of patients hospitalized for sepsis, heart attack, or stroke was no higher than with their direct admission to the ICU, the researchers believed that quality-improvement efforts should be targeted towards those patients with respiratory conditions such as pneumonia and COPD. This study was supported by AHRQ (T32 HS00028, HS19181, HS18480).
See "Risk factors for unplanned transfer to intensive care within 24 of admission from the emergency department in an integrated healthcare system," by M. Kit Delgado, M.D., Vincent Liu, M.D., Jesse M. Pines, M.D., and others in Journal of Hospital Medicine 8(1), pp. 13-19, 2013.