TY - JOUR
T1 - Delay of transfer from the intensive care unit
T2 - A prospective observational study of incidence, causes, and financial impact
AU - Johnson, Daniel W.
AU - Schmidt, Ulrich H.
AU - Bittner, Edward A.
AU - Christensen, Benjamin
AU - Levi, Retsef
AU - Pino, Richard M.
N1 - Funding Information:
We thank the nursing staff of the SICU at Massachusetts General Hospital for their assistance with data collection during the study period. The source of all funding for the entire study was the Department of Anesthesia, Critical Care and Pain Medicine at the Massachusetts General Hospital. The study was supported by the Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital. No extramural funding was used to support the study.
PY - 2013/7/4
Y1 - 2013/7/4
N2 - 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.
AB - 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.
KW - cost analysis
KW - critical care utilization
KW - organizational efficiency
KW - resource allocation
KW - triage
KW - workflow
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U2 - 10.1186/cc12807
DO - 10.1186/cc12807
M3 - Article
C2 - 23826830
AN - SCOPUS:84879827544
VL - 17
JO - Critical Care
JF - Critical Care
SN - 1364-8535
IS - 4
M1 - R128
ER -