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Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit.
C A Gold1, S A Mayer, L Lennihan
1Department of Neurology, Neurological Institute of New York, Columbia University Medical Center, New York-Presbyterian Hospital, 710 W. 168th Street, New York, NY, 10032, USA, cag2181@cumc.columbia.edu.
Neurocritical Care
|February 15, 2015
Summary
Unplanned transfers to the neurological intensive care unit (NICU) are frequent and linked to high mortality. Improving care transitions may reduce these transfers for high-risk patients.
Area of Science:
- Neurology
- Critical Care Medicine
- Healthcare Quality Improvement
Background:
- Unplanned transfers from hospital wards to neurological intensive care units (NICUs) are a concern.
- Understanding the characteristics of these transfers is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the characteristics of unplanned patient transfers from hospital wards to a NICU.
- To compare mortality rates between different types of unplanned NICU transfers.
Main Methods:
- Retrospective review of 446 consecutive unplanned transfers to a NICU over 3 years.
- Comparison of in-hospital mortality between "bounce-back" (NICU readmissions) and "incident" (non-NICU origin) transfers.
- Analysis of transfer characteristics, including source and indication.
Main Results:
- Unplanned transfers constituted 39% of NICU admissions.
- Overall in-hospital mortality for unplanned transfers was 17%, with no significant difference between bounce-back and incident transfers.
- 32% of transfers occurred within 24 hours of initial ward admission, more common in incident transfers.
Conclusions:
- Unplanned NICU transfers are common and associated with significant mortality.
- Quality improvement initiatives should focus on triage and care transitions to reduce unnecessary NICU transfers.
- Targeting high-risk patient identification and management on wards is essential.
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