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Here and Gone: Rapid Transfer From the General Care Floor to the PICU
Kathryn O Mansel1,2,3, Sophia W Chen2,3, April A Mathews1
1Departments of Medical Education and.
Insights
Rapid transfers (RTs) to the pediatric intensive care unit (PICU) in children do not increase length of stay or mortality, despite a higher rate of emergency transfers. Understanding RT characteristics is key for optimizing pediatric critical care.
Area of Science:
- Pediatric critical care medicine
- Healthcare quality improvement
- Patient safety in pediatric intensive care units
Background:
- Children admitted to general care floors may require rapid transfer (RT) to the pediatric intensive care unit (PICU).
- Investigating the characteristics and outcomes of these rapid transfers is crucial for improving care.
- Understanding factors influencing RTs can help optimize patient management and resource allocation.
Purpose of the Study:
- To characterize rapid transfers (RTs) to the PICU from general care floors.
- To evaluate the impact of RTs on patient outcomes, including PICU length of stay (LOS), mortality, and emergency transfers.
- To identify factors associated with an increased risk of RT.
Main Methods:
- A 2-year retrospective analysis of patients transferred from a general care floor to the PICU at a tertiary children's hospital.
- Patients transferred within 4 hours of admission were classified as rapid transfers (RTs).
- Statistical comparisons were made between RT and non-RT groups, including multivariate logistic regression analysis.
Main Results:
- Of 450 unplanned PICU transfers, 105 (23.3%) were classified as RTs.
- RTs were associated with a higher rate of emergency transfers (15.2% vs 7.5%) but not increased PICU LOS (2.8 vs 5.5 days) or mortality.
- Increased baseline Pediatric Overall Performance Category and PICU origin of admission were associated with a decreased risk for RT.
Conclusions:
- Rapid transfers (RTs) to the PICU are common and do not appear to increase patient mortality or length of stay.
- While RTs are associated with a higher incidence of emergency transfers, this does not translate to worse outcomes.
- Further research into the specific characteristics and management of RT patients may identify opportunities for improved care coordination and patient safety.
Background:
Children admitted to the general care floor sometimes require acute escalation of care and rapid transfer (RT) to the PICU shortly after admission. In this study, we aim to investigate the characteristics of RTs and the impact RTs have on patient outcomes, including PICU length of stay (LOS), mortality, and emergency transfer defined as critical care interventions occurring within 1 hour on either side of transfer to the PICU.
Methods:
We conducted a 2-year, single-center, retrospective analysis including all patients admitted to the general care floor of a tertiary children's hospital that were subsequently transferred to the PICU, with attention to those transferred within 4 hours of admission, meeting criteria as RTs. Patient-level data and outcomes were tracked. Statistical summaries were stratified by RT or non-RT strata and between-strata comparisons were performed. Significant univariate factors were entered into a multivariate logistic regression model and reduced with statistical significance required for final model inclusion.
Results:
Of 450 patients with an unplanned PICU transfer, 105 (23.3%) experienced RTs. Significant factors in the reduced multivariate logistic regression model associated with decreased risk for RT were increased baseline Pediatric Overall Performance Category (P = .046) and PICU origin of admission (P = .012). RT patients had shorter PICU LOSs (2.8 vs 5.5 days, P < .001) compared with non-RT patients despite a higher rate of emergency transfer (15.2% vs 7.5%, P = .018) and no difference in mortality (P = .741).
Conclusions:
In this study, we demonstrate RTs have an increase in emergency transfer rate but no apparent risk of increased PICU LOS or mortality.
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