Off-Hours Intensive Care Unit Transfer Is Associated With Increased Mortality and Failure to Rescue

Area of Science:

• Cardiology
• Critical Care Medicine
• Health Services Research

Background:

• Intensive care unit (ICU) beds are a limited resource in cardiac postoperative care.
• Patients requiring less intensive care are promptly transferred from the ICU.
• The timing of transfer may influence patient outcomes, particularly during off-hours.

Purpose of the Study:

• To investigate the association between ICU transfer timing (off-hours vs. regular hours) and patient outcomes after cardiac surgery.
• To determine if off-hours transfers correlate with increased postoperative complications, ICU readmissions, or mortality.
• To identify potential targets for quality improvement in postoperative care pathways.

Main Methods:

• A retrospective cohort study of 5951 patients undergoing cardiac surgery from 2010 to 2021.
• Patients were stratified into off-hours (9 pm-5 am) and regular-hours groups based on ICU transfer time.
• Risk-adjusted multivariable logistic regression was used to analyze outcomes including ICU readmission, complications, operative mortality, and failure to rescue.

Main Results:

• Patients transferred during off-hours (4.9% of cohort) had significantly higher odds of ICU readmission (OR 1.99) and mortality (OR 3.88).
• In a subgroup with major complications, off-hours transfer was linked to increased mortality (failure to rescue) (OR 3.05).
• Off-hours transfers were associated with greater odds of postoperative complications and ICU readmission.

Conclusions:

• Transferring patients from the ICU to the floor during off-hours is associated with adverse postoperative outcomes.
• The timing of ICU transfer appears to be a critical factor impacting patient safety and recovery after cardiac surgery.
• These findings suggest opportunities for process improvement in managing patient flow and resource allocation within cardiac surgical units.