TY - JOUR
T1 - Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit
AU - Odetola, Folafoluwa O.
AU - Clark, Sarah J.
AU - Gurney, James G.
AU - Dechert, Ronald E.
AU - Shanley, Thomas P.
AU - Freed, Gary L.
N1 - Funding Information:
This study was funded by the Michigan Mentored Clinical Scholars' Program NIH 5 K12 RR017607-04.
PY - 2009/9
Y1 - 2009/9
N2 - Purpose: The study aimed to examine the effect of interhospital transfer on resource utilization and clinical outcomes at a tertiary pediatric intensive care unit (PICU) among patients with sepsis or respiratory failure. Materials and methods: Data on 2146 consecutive admissions with respiratory failure or sepsis to the PICU were analyzed. Data included demographics, admission source, and outcomes. Admission source was classified as interhospital transfer from the emergency departments (ED), wards, or PICUs of referring hospitals; or from the study hospital ED (direct). Results: Compared with direct admissions, inter-PICU transfers had higher crude mortality (odds ratio, 1.93; 95% confidence interval, 1.31-2.84) but not significant mortality difference (odds ratio, 1.16; 95% confidence interval, 0.71-1.86) after adjusting for illness severity, age, and sex. Conversely, ED transfers had lower PICU mortality than direct ED admissions. Children with transfer admissions stayed significantly longer and used more intensive care technology in the study PICU than children directly admitted (P < .01). In comparisons within quartiles of mortality risk, inter-PICU transfers had longer hospitalization and higher mortality in all but the highest quartile. Conclusions: Interhospital transfer, particularly inter-PICU transfer, was associated with significant hospital resource consumption that often correlated with admission illness severity. Future prospective studies should identify determinants of pretransfer illness severity and investigate decision making underlying interhospital transfer.
AB - Purpose: The study aimed to examine the effect of interhospital transfer on resource utilization and clinical outcomes at a tertiary pediatric intensive care unit (PICU) among patients with sepsis or respiratory failure. Materials and methods: Data on 2146 consecutive admissions with respiratory failure or sepsis to the PICU were analyzed. Data included demographics, admission source, and outcomes. Admission source was classified as interhospital transfer from the emergency departments (ED), wards, or PICUs of referring hospitals; or from the study hospital ED (direct). Results: Compared with direct admissions, inter-PICU transfers had higher crude mortality (odds ratio, 1.93; 95% confidence interval, 1.31-2.84) but not significant mortality difference (odds ratio, 1.16; 95% confidence interval, 0.71-1.86) after adjusting for illness severity, age, and sex. Conversely, ED transfers had lower PICU mortality than direct ED admissions. Children with transfer admissions stayed significantly longer and used more intensive care technology in the study PICU than children directly admitted (P < .01). In comparisons within quartiles of mortality risk, inter-PICU transfers had longer hospitalization and higher mortality in all but the highest quartile. Conclusions: Interhospital transfer, particularly inter-PICU transfer, was associated with significant hospital resource consumption that often correlated with admission illness severity. Future prospective studies should identify determinants of pretransfer illness severity and investigate decision making underlying interhospital transfer.
KW - Critical illness
KW - Outcome assessment
KW - Patient transfer
KW - Pediatric intensive care units
KW - Risk
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U2 - 10.1016/j.jcrc.2008.11.007
DO - 10.1016/j.jcrc.2008.11.007
M3 - Article
C2 - 19327327
AN - SCOPUS:67949112879
SN - 0883-9441
VL - 24
SP - 379
EP - 386
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 3
ER -