Impact of the misclassification of the severity at the time of entry in the hospital on critically ill respiratory patients' prognosis

Abstract

Introduction: Frequently there is an important delay in the admission to the Respiratory Intermediate Care Units (RICUs), which may have a negative impact. Objective: To assess the impact of misclassification of the severity at the time of entry in the hospital on respiratory critically ill patients. Methods: We designed a retrospective study with a cohort of patients admitted to the RICU between February 2007 and October 2015. Two groups were defined depending if they were admitted directly from the emergency department (ED group) or transferred later from the conventional hospital ward (CHW group). At the time of entry in the hospital patients presented similar severity of their respiratory process. We compared the demographic features, clinical items, APACHE II, Charlson Index, delay in RICU admission, hospital stay, mortality and readmission of both groups. Results: 1522 patients were included, 1155 from the ED group and 367 from the CHW group. At the time of entry in the hospital no differences were observed between both groups for the assessed variables. However, patients from the CHW group accumulated more hours of delay and had a worse APACHE II score at the time of admission to the RICU than the ED group, differences that resulted to be statistically significant. Length of hospital stay was of 7.52 (6.61) days for ED group and 9.29 (8.12) days for the CHW group (p Conclusion: Delayed admission to the RICU might lead to a worse prognosis in respiratory critically ill patients.