Association between intensive care unit transfer delay and hospital mortality: A multicenter investigation
Open accessAbstract
BACKGROUND: Previous research investigating the impact of delayed intensive care unit (ICU) transfer on outcomes has utilized subjective criteria for defining critical illness. OBJECTIVE: To investigate the impact of delayed ICU transfer using the electronic Cardiac Arrest Risk Triage (eCART) score, a previously published early warning score, as an objective marker of critical illness. DESIGN: Observational cohort study. SETTING: Medical‐surgical wards at 5 hospitals between November 2008 and January 2013. PATIENTS: Ward patients. INTERVENTION: None. MEASUREMENTS: eCART scores were calculated for all patients. The threshold with a specificity of 95% for ICU transfer (eCART ≥ 60) denoted critical illness. A logistic regression model adjusting for age, sex, and surgical status was used to calculate the association between time to ICU transfer from first critical eCART value and in‐hospital mortality. RESULTS: A total of 3789 patients met the critical eCART threshold before ICU transfer, and the median time to ICU transfer was 5.4 hours. Delayed transfer (>6 hours) occurred in 46% of patients (n = 1734) and was associated with increased mortality compared to patients transferred early (33.2% vs 24.5%, P < 0.001). Each 1‐hour increase in delay was associated with an adjusted 3% increase in odds of mortality ( P < 0.001). In patients who survived to discharge, delayed transfer was associated with longer hospital length of stay (median 13 vs 11 days, P < 0.001). CONCLUSIONS: Delayed ICU transfer is associated with increased hospital length of stay and mortality. Use of an evidence‐based early warning score, such as eCART, could lead to timely ICU transfer and reduced preventable death. Journal of Hospital Medicine 2016;11:757–762. © 2016 Society of Hospital Medicine
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Early ICU transfer is a window of critical opportunity for timely clinical interventions that alter the trajectory of a patient's clinical progression, prevent adverse outcomes and improve survival.
“Early ICU transfer has been shown to be a ‘window of critical opportunity’ for timely clinical interventions that alter the trajectory of a patient’s clinical progression, prevent adverse outcomes and improve survival35–39.”
From Real-time surveillance system for patient deterioration: a pragmatic cluster-randomized controlled trial (2025) · cites this paper as [36]
The Introduction says early ICU transfer for treatment may improve outcomes, and the Discussion reports that delayed transfer was associated with higher hospital mortality. But the Discussion also says this observational study cannot estimate the true impact of timely transfer. It does not establish that early transfer enables interventions that alter a patient's trajectory or prevent adverse outcomes. (LLM, conf=0.86)
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Self-citation
- Authors
- Churpek, M. M., Wendlandt, B., Zadravecz, F. J., Adhikari, R., Winslow, C., & Edelson, D. P.
- Affiliations
- University of Chicago (US)
- Endeavor Health (US)
- Corresponding author
- Churpek, Matthew M.
- Venue
- Journal of Hospital Medicine
- Publisher
- Wiley
- Published
- 2016-06-28
- Volume
- 11
- Issue
- 11
- Pages
- 757-762
- ISSN
- 1553-5592 (ISSN-L)
- 1553-5606
- PMC
- PMC5119525
- OpenAlex
- W2469363752
- Cited by
- 143
- References
- 25
- Citations by year
- 2026: 19 · 2025: 17 · 2024: 18 · 2023: 12 · 2022: 19 · 2021: 15 · 2020: 19 · 2019: 10 · 2018: 12 · 2017: 1 · 2016: 1
- FWCI
- 10.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Hospital Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Clinical and Translational Science Award (UL1 RR024999)
- National Heart, Lung, and Blood Institute (K08 HL121080)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- ICU transfer, transfer delay, in-hospital mortality, early warning scores, critical illness, length of hospital stay, ward patients, medical and surgical wards
- MeSH terms
- Aged, Aged, 80 and over, Female, Heart Arrest, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Patient Transfer, Time Factors, Cohort Studies, Critical Illness, Hospital Mortality, Vital Signs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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