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HomeAmerican Journal of Critical Careindex/list_12092_1Unplanned Transfers From Intermediate Care Units to Intensive Care Units

Unplanned Transfers From Intermediate Care Units to Intensive Care Units

Abstract and Introduction

Abstract

This study evaluated unplanned transfers from the intermediate care unit (IMCU) to the intensive care unit (ICU) among urgent admissions. This retrospective, observational study was conducted in 2 ICUs and 1 IMCU. Three patterns of urgent admission were assessed: admissions to the ICU only, admissions to the IMCU only, and admissions to the IMCU with subsequent transfer to the ICU. Of 5296 admissions analyzed, 1396 patients (26.4%) were initially admitted to the IMCU. Of these, 172 (12.3%) were transferred from the IMCU to the ICU. Mortality was higher in patients transferred from the IMCU to the ICU than in the 3900 ICU-only patients (odds ratio, 3.22; 95% CI, 1.52–6.80). Most transfers from the IMCU to the ICU (135; 78.5%) were due to deterioration of the condition for which the patient was admitted. Patient transfers from the IMCU to the ICU were common, were associated with increased hospital mortality, and were mostly due to deterioration in the condition that was the reason for admission.

Introduction

The role of admission to the intermediate care unit (IMCU) for patients with potentially unstable conditions is unclear.[1] The Society of Critical Care Medicine guidelines regarding admission to the intensive care unit (ICU) suggest using a prioritization model indicating that patients requiring lower-level care could be treated in IMCUs.[2] However, this recommendation may be problematic when resources are readily available and there is no explicit need for rationing care.

Unplanned admission of patients with potentially unstable conditions to the IMCU with later transfer to the ICU if further deterioration occurs (a step-up approach)[2] may be associated with delay in access to ICU-level care and worse outcomes,[3–5] especially because prediction of deteriorating condition in this population is difficult.[6–8]

In this study, we evaluated the occurrence of step-up transfers from the IMCU to the ICU among patients admitted urgently and assessed the impact of such transfers on outcomes. Specifically, we assessed the relationship between the reason for transfer and the original reason for admission.

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