Adverse outcomes of delayed intensive care unit

Area of Science:

• Critical Care Medicine
• Hospital Operations
• Patient Outcomes Research

Background:

• Timely transfer from the emergency room (ER) to the intensive care unit (ICU) is crucial for critically ill patients.
• Understanding the impact of ER-to-ICU delays on patient outcomes is essential for optimizing hospital resource allocation and patient care.

Purpose of the Study:

• To investigate the association between delayed transfer from the emergency room to the intensive care unit and its effects on ICU length of stay and patient mortality.
• To identify factors influencing prolonged ICU stays.

Main Methods:

• A prospective cohort study involving 1913 patients requiring ICU admission from the ER at a tertiary academic hospital.
• Patients were stratified into tertiles based on waiting time for ICU admission (Group 1: <637 min, Group 2: 637-1602 min, Group 3: >1602 min).
• Prolonged ICU stay was defined as longer than the median length of stay (3.2 days).

Main Results:

• Of 6,176 ER patients, 1,913 (31%) required ICU admission. The median ER stay was 17 hours.
• Hospitalization for infection/sepsis independently predicted prolonged ICU stay (OR 2.75).
• Waiting time for ICU admission was not a significant predictor of prolonged ICU stay or increased mortality, although Group 3 showed a non-significant trend towards higher mortality (38% vs. 31% in Group 1).

Conclusions:

• Delayed ICU admission from the ER did not significantly increase ICU length of stay.
• Delayed ICU admission from the ER did not significantly increase patient mortality.
• Infection/sepsis is a key factor associated with prolonged ICU stays, independent of transfer delays.