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Impact of interhospital intensive care unit transfers

Duke University Medical Center is a tertiary referral level one trauma hospital with a 16 bed surgical intensive care unit (SICU) averaging 1100 admissions per year. SICU patients include trauma, gastrointestinal, vascular, transplant, urology, orthopedics, otolaryngology and gynecology services. SICU admissions consist of postoperative, trauma via emergency room, intrahospital floor transfer and interhospital direct transfer. Transfers from outside institutions are often critically ill patients who have a significantly prolonged length of stay (LOS) and use vast amounts of resources.

All SICU admissions were compared with interhospital transfers for the last 3 fiscal years.

Interhospital transfers account for 5% of ICU admissions but 10% of total costs. These patients generate increased cost per case of over $11,000. The ICU LOS is significantly increased from 3.3 days for all patients to 7.5 for transfers. Likewise, the SICU mortality of these cases is significantly increased from 7.3% to 28.6% and hospital mortality from 9.6% to 33.5%

We continually review our practices to dedicate our resources where they do the most good. We must continue to take salvageable, critically ill patients in transfer early in the course of their illness when appropriate SICU management can favorably influence outcome. In our experience, interhospital transfer of critically ill patients identifies a group with overall poor prognosis. There is a need for a means to evaluate and appropriately triage outside referrals in order to maximize clinical outcomes. Analysis of these transfers is underway to identify prospective predictors of potentially futile care to allow better utilization of available resources.

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Knudsen, N., Fulkerson, W., Vaslef, S. et al. Impact of interhospital intensive care unit transfers. Crit Care 5 (Suppl 1), P173 (2001).

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