Delayed Admission to the Intensive Care Unit Is Associated With Increased Mortality Risk in Critically Ill Patients:
Shivaprasad Anagi1,2,3, Diane Chamberlain3,4, Nigel Barr5
1Older Persons Emergency Network, Metro North Hospital and Health Services, Brisbane, Queensland, Australia.
Insights
Delayed intensive care unit (ICU) admission significantly increases patient mortality, especially for those with worsening organ dysfunction. Expediting transfers for deteriorating patients is crucial for better outcomes in Australian hospitals.
Area of Science:
- Critical Care Medicine
- Hospital Operations
- Patient Safety
Background:
- Delays in intensive care unit (ICU) admission are a concern for patients experiencing acute deterioration.
- Effective triage and transfer protocols are vital for managing critically ill patients.
Purpose of the Study:
- To investigate the association between delayed ICU admission and patient outcomes.
- To analyze the impact of delays on mortality and organ dysfunction (SOFA scores).
Main Methods:
- Prospective cohort study over 12 months in a regional Australian hospital.
- Included adult patients transferred from ED or wards to ICU.
- Measured ICU admission delays, mortality, and Sequential Organ Failure Assessment (SOFA) scores.
Main Results:
- 68.5% of 403 patients experienced delayed ICU admission (median 7.13 hours).
- Delayed admission was linked to increased mortality.
- Higher SOFA scores significantly correlated with higher mortality odds.
Conclusions:
- Delayed ICU admission is a significant risk factor for increased mortality.
- Elevated SOFA scores in patients with delayed admission indicate greater clinical instability.
- Improved triage and transfer systems are essential to reduce harm and improve outcomes for deteriorating patients.
Aim:
To examine the impact of delays in intensive care unit (ICU) admission on patient outcomes, specifically clinical deterioration and mortality among patients transferred from the emergency department (ED) or general wards following acute deterioration in an Australian public hospital.
Design & Methods:
This prospective cohort study was conducted over a 12-month period (15 April 2022-14 April 2023) in a 209-bed regional hospital. It included adult patients (aged ≥ 18 years) admitted to the ICU from ED or general wards following acute deterioration. Primary outcomes measured were duration of delay in ICU admission, ICU and hospital mortality and changes in Sequential Organ Failure Assessment (SOFA) scores over time to assess organ dysfunction and progression.
Results:
A total of 403 patients were included. Of these, 276 (68.5%) experienced delays in ICU admission, ranging from 25 min to 347.25 h (median: 7.13 h). Delayed ICU admission was associated with increased mortality. Each one-point increase in the highest recorded SOFA score was linked to a 7.5% rise in mortality odds, while each one-point increase in the initial or 24-h SOFA score corresponded to a 6.8% increase.
Conclusions:
Delayed ICU admission was significantly associated with increased mortality, particularly in patients with elevated SOFA scores, indicating worsening organ dysfunction and clinical instability.
Implications For Practice:
These findings highlight the urgent need for improved triage systems, early warning protocols and streamlined escalation pathways to expedite ICU transfers for deteriorating patients. Timely intervention is essential to reduce harm and improve outcomes.
Impact:
This study reinforces the clinical risks of delayed ICU admission and supports timely escalation of care in emergency and ward settings across Australian public hospitals.
Reporting:
Conducted in accordance with STROBE guidelines.
Patient/Public Contribution:
No direct patient or public involvement. The study used routinely collected clinical data to evaluate systemic and clinical outcomes.
More Related Videos
Related Concept Videos
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:30Acute Respiratory Failure-III
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention