Abstract
BackgroundPatients in the intensive care unit (ICU) are increasingly being transferred between ICUs due to a shortage of ICU beds, although this practice is potentially harmful. However, in tertiary units, the transfer of patients who are not in need of highly specialized care is often necessary. The aim of this study was to assess the association between a 90-day mortality and inter-hospital transfer due to a shortage of ICU beds in a tertiary centre.MethodsData were retrieved from the local ICU database from December 2011 to September 2019. The primary analysis was a risk-adjusted logistic regression model. Secondary analyses comprised case/control (transfer/non-transfer) matching.ResultsA total of 573 patients were transferred due to a shortage of ICU beds, and 8106 patients were not transferred. Crude 90-day mortality was higher in patients transferred due to a shortage of beds (189 patients (33%) vs 2188 patients (27%), p = 0.002). In the primary, risk-adjusted analysis, the risk of death at 90 days was similar between the groups (odds ratio 0.923, 95% confidence interval 0.75–1.14, p = 0.461). In the secondary analyses, a 90-day mortality was similar in transferred and non-transferred patients matched according to SAPS 3-score, age, days in the ICU and ICU diagnosis (p = 0.407); SOFA score on the day of discharge, ICU diagnosis and age (p = 0.634); or in a propensity score model (p = 0.229).ConclusionMortality at 90 days in critically ill patients treated in a tertiary centre was not affected by transfer to another intensive care units due to a shortage of beds. We found this conclusion to be valid under the assumption that patients are carefully selected and that the transports are safely performed.
Highlights
Patients in the intensive care unit (ICU) are increasingly being transferred between intensive care units (ICUs) due to a shortage of ICU beds, this practice is potentially harmful
While it has been reported that when compared with directly admitted patients, critically ill patients referred to a tertiary centre have a similar adjusted mortality [11], we have found no analysis of the comparative mortality of patients transferred from a tertiary ICU due to a limited capacity
5145 were excluded due to admission for scheduled postoperative care. Another 1841 patients were excluded due to transfer within the same hospital or to highly specialized units, e.g., a burn-centre or paediatric ICU, or transfer to their home hospital after specialized care
Summary
Patients in the intensive care unit (ICU) are increasingly being transferred between ICUs due to a shortage of ICU beds, this practice is potentially harmful. The aim of this study was to assess the association between a 90-day mortality and inter-hospital transfer due to a shortage of ICU beds in a tertiary centre. Inter-hospital transfer of critically ill patients between intensive care units (ICUs) is a common practice in Sweden [1] This procedure is considered a means of providing best care when a patient in need of highly (2020) 8:82 ambulance systems with equipment and personnel allocated to maintain intensive care during transportation. While it has been reported that when compared with directly admitted patients, critically ill patients referred to a tertiary centre have a similar adjusted mortality [11], we have found no analysis of the comparative mortality of patients transferred from a tertiary ICU due to a limited capacity This is an unanswered question in everyday practice in a tertiary centre where patient turnover is steadily increasing due to centralization and technical development of care. The aim of this study was to assess the association between mortality and inter-hospital transfer from a tertiary centre ICU to other ICUs due to a shortage of ICU beds
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
