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A6839 - Arrival to the ICU During Night Shift Is More Frequent in Infected Patients Directly Admitted to the ICU Compared to Transfers from the Floor
Author Block: S. P. Taylor, C. Karvetski, C. Lewis, A. Heffner, B. T. Taylor; Carolinas Medical Center, Charlotte, NC, United States.
Patients requiring early transfer from medical wards to the intensive care unit (ICU) have high in-hospital mortality and marked increases in resource utilization compared to patients directly admitted to the ICU. Furthermore, the timing of ICU admission, whether during day or night shift, may have effects on patient outcomes. Because there is some evidence that patients are more likely to be refused ICU transfer overnight than during day shifts, we hypothesized that direct ICU admissions might be more likely to be nighttime admissions compared to ICU transfers from the medical floor. Methods: Retrospective analysis of patients admitted from 9 Emergency Departments in our healthcare system with suspected infection at risk for clinical deterioration. This cohort, referred to as Infection Present on Admission (POA), is defined as a final primary or any secondary discharge diagnosis for UTI, bacteremia, pneumonia, cellulitis, C Diff, septicemia, sepsis, severe sepsis, or septic shock where the diagnosis was coded as present on admission. We evaluated patients who required an ICU admission within the first 72 hours of hospitalization. Patients admitted from the ED to the ICU were termed direct ICU admit patients. Transfers to the ICU after a patient's initial admission to the floor were termed delayed ICU transfers; we separated delayed transfers into those occurring within the first 12h and those occurring between 12-72h. Results: Of the 13,441 patients with infection POA requiring ICU admission within 72h, 11,605 (84.2%) were directly admitted to the ICU, 638 (4.6%) were transferred in the first 12h, and 1198 (8.7%) were transferred between 12-72h. Age, sex, and APACHE IVa scores at the time of ICU admission were similar for patients requiring direct ICU admission versus transfer at any time. Regarding day versus nighttime admission, 65.8% of patients directly admitted to the ICU compared with 49.2% and 41.1% of patients transferred at 12 and 12-72h were admitted during night shift (p=0.02). Patients with direct ICU admission had similar mortality (13.9%) to patients with delayed transfer within 12h (12.1%), and 12-72h (15.3%). Conclusions: In a large, multi-center study of patients hospitalized with infection, we found that patients directly admitted to the ICU have a higher proportion of nighttime ICU admissions compared to patients transferred to the ICU, who are more likely to arrive in the ICU during day shift. Nighttime arrival to the ICU may modify the effect of direct versus transfer admission on outcomes in patients with infection or sepsis.