Interhospital transfer of critically ill patients: Demographic and outcomes comparison with nontransferred intensive care unit patients

Hill, Andrea D.; Vingilis, Evelyn; Martin, Claudio M.; Hartford, Kathleen; Speechley, Kathy N.

doi:10.1016/j.jcrc.2007.06.002

« Previous Next »Journal of Critical Care
Volume 22, Issue 4 , Pages 290-295, December 2007

Interhospital transfer of critically ill patients: Demographic and outcomes comparison with nontransferred intensive care unit patients☆☆☆

Andrea D. Hill, MSc
- Department of Medicine, London Health Sciences Centre, Ontario, Canada
- Corresponding author. Tel.: +1 416 340 4800x2765.
Evelyn Vingilis, PhD
- Department of Family Medicine, University of Western Ontario, Ontario, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, Ontario, Canada
Claudio M. Martin, MD, MSc, FRCPC
- Centre for Critical Illness Research, Lawson Health Research Institute, London Health Sciences Centre, Ontario, Canada
- Department of Medicine, University of Western Ontario, Ontario, Canada
Kathleen Hartford, PhD
- Department of Epidemiology and Biostatistics, University of Western Ontario, Ontario, Canada
- School of Nursing, University of Western Ontario, Ontario, Canada
Kathy N. Speechley, PhD
- Department of Epidemiology and Biostatistics, University of Western Ontario, Ontario, Canada
- Department of Paediatrics, University of Western Ontario, Ontario, Canada

Abstract

Purpose

We examined the association between access to intensive care services and mortality in a cohort of critically ill patients.

Materials and Methods

We conducted an observational study involving 6298 consecutive admissions to the intensive care units (ICUs) of a tertiary care hospital. Data including demographics, admission source, and outcomes were collected on all patients. Admission source was classified as “transfer” for patients admitted to the ICU from other hospitals, “ER” for patients admitted from the emergency room, and “ward” for patients admitted from non-ICU inpatient wards.

Results

Transfer patients had higher crude ICU and hospital mortality rates compared with emergency room admissions (crude odds ratio [OR], 1.51; 95% confidence interval [CI], 1.32-1.75). After adjusting for age, sex, diagnosis, comorbidities, and acute physiology scores, the difference in ICU mortality remained significant (OR, 1.30; 95% CI, 1.09-1.56); however, hospital mortality did not (OR, 1.19; 95% CI, 1.00-1.41). Compared with ward patients, transfer from other hospitals was associated with lower hospital mortality after adjusting for severity of illness and other case-mix variables (OR, 0.81; 95% CI, 0.68-0.95).

Conclusions

We found some evidence to suggest that differential access to intensive care services impacts mortality within this case mix of patients. These findings may have implications for current efforts to centralize and regionalize critical care services.

Keywords: Intensive care, Health services, Accessibility, Critically ill