Delay of transfer from the intensive care unit: A prospective observational study of incidence, causes, and financial impact

Daniel W Johnson, Ulrich H. Schmidt, Edward A. Bittner, Benjamin Christensen, Retsef Levi, Richard M. Pino

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Introduction: A paucity of literature exists regarding delays in transfer out of the intensive care unit. We sought to analyze the incidence, causes, and costs of delayed transfer from a surgical intensive care unit (SICU).Methods: An IRB-approved prospective observational study was conducted from January 24, 2010, to July 31, 2010, of all 731 patients transferred from a 20-bed SICU at a large tertiary-care academic medical center. Data were collected on patients who were medically ready for transfer to the floor who remained in the SICU for at least 1 extra day. Reasons for delay were examined, and extra costs associated were estimated.Results: Transfer to the floor was delayed in 22% (n = 160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean, 1.5 days; median, 2 days). The extra costs associated with delays were estimated to be $581,790 during the study period, or $21,547 per week. The most common reasons for delay in transfer were lack of available surgical-floor bed (71% (114 of 160)), lack of room appropriate for infectious contact precautions (18% (28 of 160)), change of primary service (Surgery to Medicine) (7% (11 of 160)), and lack of available patient attendant ("sitter" for mildly delirious patients) (3% (five of 160)). A positive association was found between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman rho = 0.27; P < 0.0001).Conclusions: Delay in transfer from the SICU is common and costly. The most common reason for delay is insufficient availability of surgical-floor beds. Delay in transfer is associated with high hospital census. Further study of this problem is necessary.

Original languageEnglish (US)
Article numberR128
JournalCritical Care
Volume17
Issue number4
DOIs
StatePublished - Jul 4 2013

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Critical Care
Observational Studies
Intensive Care Units
Prospective Studies
Incidence
Censuses
Costs and Cost Analysis
Research Ethics Committees
Tertiary Healthcare
Medicine

Keywords

  • cost analysis
  • critical care utilization
  • organizational efficiency
  • resource allocation
  • triage
  • workflow

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Delay of transfer from the intensive care unit : A prospective observational study of incidence, causes, and financial impact. / Johnson, Daniel W; Schmidt, Ulrich H.; Bittner, Edward A.; Christensen, Benjamin; Levi, Retsef; Pino, Richard M.

In: Critical Care, Vol. 17, No. 4, R128, 04.07.2013.

Research output: Contribution to journalArticle

Johnson, Daniel W ; Schmidt, Ulrich H. ; Bittner, Edward A. ; Christensen, Benjamin ; Levi, Retsef ; Pino, Richard M. / Delay of transfer from the intensive care unit : A prospective observational study of incidence, causes, and financial impact. In: Critical Care. 2013 ; Vol. 17, No. 4.
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