Cited by 143Cardiac Arrest and ResuscitationSepsis Diagnosis and TreatmentHospital Admissions and Outcomes

Association between intensive care unit transfer delay and hospital mortality: A multicenter investigation

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Churpek, Matthew M., Wendlandt, Blair, Zadravecz, Frank J., Adhikari, Richa, Winslow, Christopher, Edelson, Dana P.·2016·Journal of Hospital Medicine

Abstract

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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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
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
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

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