“Deterioration to Door Time”: An Exploratory Analysis of Delays in Escalation of Care for Hospitalized Patients
Open accessAbstract
Background Timely escalation of care for patients experiencing clinical deterioration in the inpatient setting is challenging. Deterioration on a general floor has been associated with an increased risk of death, and the early period of deterioration may represent a time during which admission to the intensive care unit (ICU) improves survival. Previous studies examining the association between delay from onset of clinical deterioration to ICU transfer and mortality are few in number and were conducted more than 10 years ago. Objective We aimed to evaluate the impact of delays in the escalation of care among clinically deteriorating patients in the current era of inpatient medicine. Design and participants This was a retrospective cohort study that analyzed data from 793 patients transferred from non-intensive care unit (ICU) inpatient floors to the medical intensive care unit (MICU), from 2011 to 2013 at an urban, tertiary, academic medical center. Main measures "Deterioration to door time (DTDT)" was defined as the time between onset of clinical deterioration (as evidenced by the presence of one or more vital sign indicators including respiratory rate, systolic blood pressure, and heart rate) and arrival in the MICU. Key results In our sample, 64.6 % had delays in care escalation, defined as greater than 4 h based on previous studies. Mortality was significantly increased beginning at a DTDT of 12.1 h after adjusting for age, gender, and severity of illness. Conclusions Delays in the escalation of care for clinically deteriorating hospitalized patients remain frequent in the current era of inpatient medicine, and are associated with increased in-hospital mortality. Development of performance measures for the care of clinically deteriorating inpatients remains essential, and timeliness of care escalation deserves further consideration.
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Mortality increases when care escalation is delayed.
“Mortality increases when care escalation is delayed47; therefore, transparency and explainability, achieved by displaying the CONCERN score and factors driving the prediction, may overcome the dissonance between nurses’ identification of patient risk based on subtle clinical indicators and prescribing providers’ expectations of changes in physiological data, thereby prompting earlier decisions to”
From Real-time surveillance system for patient deterioration: a pragmatic cluster-randomized controlled trial (2025) · cites this paper as [47]
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- Authors
- Sankey, C. B., McAvay, G., Siner, J. M., Barsky, C. L., & Chaudhry, S. I.
- Affiliations
- Yale New Haven Hospital (US)
- Yale University (US)
- Hackensack University Medical Center (US)
- Corresponding author
- Sankey, Christopher B.
- Venue
- Journal of General Internal Medicine
- Published
- 2016-03-11
- Volume
- 31
- Issue
- 8
- Pages
- 895-900
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC4945556
- OpenAlex
- W2293326121
- Cited by
- 60
- References
- 35
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 6 · 2023: 9 · 2022: 7 · 2021: 6 · 2020: 4 · 2019: 10 · 2018: 6 · 2017: 1 · 2016: 2
- FWCI
- 8.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Yale University
- National Institutes of Health (UL1TR001863, KL2TR001862)
- Agency for Healthcare Research and Quality
- Raymond and Beverly Sackler Institute for Biological, Physical and Engineering Sciences, Yale University
- National Institute on Aging (P30AG021342)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- clinical deterioration, treatment escalation, ICU transfer, medical intensive care unit, in-hospital mortality, vital signs, timeliness of care, hospitalized patients, performance indicators
- MeSH terms
- Clinical Deterioration, Adolescent, Adult, Aged, Aged, 80 and over, Emergency Service, Hospital, Female, Hospitalization, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Patient Transfer, Retrospective Studies, Young Adult, Electronic Health Records, Time-to-Treatment
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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