Intra-Hospital Transfers to a Higher Level of Care: Contribution to Total Hospital and Intensive Care Unit (ICU) Mortality and Length of Stay (LOS)
Intra-Hospital Transfers to a Higher Level of Care: Contribution to Total Hospital and Intensive Care Unit (ICU) Mortality and Length of Stay (LOS)
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DOI：
10.1002/jhm.817
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发表时间：
2011-02-01
影响因子：
2.6
通讯作者：
Kipnis, Patricia
中科院分区：
文献类型：
--
作者：
Escobar, Gabriel J.;Greene, John D.;Kipnis, Patricia
背景技术背景：众所周知，经历院内转移到更高级别护理（例如，病房到重症监护室[ICU]）的患者死亡率较高。然而，这些发现是基于单中心研究或采用ICU入院作为分母的研究。目的：采用自动化床位历史数据，以所有医院入院作为分母，检查院内转移的结果。设计：回顾性队列研究。地点：共19家急性护理医院。患者：2006年11月1日至2008年1月31日期间，共有150，495名患者入住这些医院，其中210，470人住院。预测因素包括年龄、性别、入院类型、入院诊断、入院时的生理紊乱和既存疾病负担;结局包括：1）院内转运的发生，2）入院后死亡，3）转运后死亡，4）总住院时间（LOS）。一共7个，868例住院，开始于普通内科外科病房或过渡性护理病房（TCU）至少有一次转到更高级别的护理。这些住院仅占所有入院的3.7%，但占所有ICU入院的24.2%，占所有住院死亡的21.7%，占所有住院天数的13.2%。基于年龄、性别、入院前实验室检查结果和合并症的模型并不能预测这些转移的发生。结论：入院后转移到更高级别护理的患者死亡率和LOS过高。医院医学杂志2011;6：74-80。(C)2011年医院医学会。
BACKGROUND: Patients who experience intra-hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single-center studies or studies that employ ICU admissions as the denominator.OBJECTIVE: To employ automated bed history data to examine outcomes of intra-hospital transfers using all hospital admissions as the denominator.DESIGN: Retrospective cohort study.SETTING: A total of 19 acute care hospitals.PATIENTS: A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008.MEASUREMENTS: Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre-existing illness burden; outcomes were: 1) occurrence of intra-hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS).RESULTS: A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers.CONCLUSIONS: Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS. Journal of Hospital Medicine 2011;6:74-80. (C) 2011 Society of Hospital Medicine.